Minimum Number of MRI Ultrasound Fusion Targeted Biopsy Cores Needed for Prostate Cancer Detection: Multivariable Retrospective Lesion-Based Analyses of Patients Treated with Radical Prostatectomy.

Abstract

OBJECTIVE\nTo analyze the number of mpMRI targeted biopsy (TBx) cores per lesion needed for PCa detection in patients treated with radical prostatectomy (RP).\n\n\nMATERIAL AND METHODS\nAnalyses focus on TBx of PCa suspicious MRI lesions (PI-RADS ≥3) with consecutive RP. Descriptive statistics included frequencies/proportions and interquartile ranges (IQR). Multivariable logistic regression analyses (MVA) on per lesion level predicted the number of TBx with PCa.\n\n\nRESULTS\nIn the total cohort of 771 RP patients, 437 (57%) and 334 (43%) were either systematic transrectal ultrasound-guided biopsy (SBx) naïve or had ≥1 prior negative SBx. A maximum PI-RADS score of 3, 4 and 5 was present in 67 (8.7%), 567 (74%) and 137 (18%) patients. A total of 1,459 of tumor suspicious mpMRI lesions PCa were identified for analyses. PCa detection was made based on initial, second, third or ≥ fourth TBx in 79%, 92%, 98% and 100%, respectively. PCa detection on first TBx core only increased with higher PI-RADS score (3, 4 and 5) from 67%, 79% and 87%. Number of prior negative SBx and pathological tumor stage emerged as independent predictors in MVA addressing the need of ≥2 TBx cores necessary for csPCa detection.\n\n\nCONCLUSIONS\nRP based analyses demonstrate that the majority of cancers can be detected by two TBx only and in minority of cases three and more TBx are necessary. Such findings might indicate that TBx procedure and related technology have improved, especially in intermediate/high-risk PCa patients.