Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study.

Humans Image-Guided Biopsy / methods Magnetic Resonance Imaging / methods Male Prostate / diagnostic imaging Prostatic Neoplasms / diagnostic imaging Risk Assessment
Combined biopsy Fusion biopsy Prostate Imaging-Reporting and Data System Prostate cancer Prostate cancer diagnosis Prostate magnetic resonance imaging

Journal

European urology oncology
ISSN: 2588-9311
Titre abrégé: Eur Urol Oncol
Pays: Netherlands
ID NLM: 101724904

Informations de publication

Date de publication:
04 2022
Historique:
received: 04 12 2020
revised: 21 02 2021
accepted: 19 03 2021
pubmed: 14 4 2021
medline: 14 5 2022
entrez: 13 4 2021
Statut: ppublish

Résumé

While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa. To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC). Men with MRI-visible prostate lesions underwent combined TBx plus SBx. The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score. Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (8% vs 7.5%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%). While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%). Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544.

Sections du résumé

BACKGROUND
While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa.
OBJECTIVE
To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC).
DESIGN, SETTING, AND PARTICIPANTS
Men with MRI-visible prostate lesions underwent combined TBx plus SBx.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score.
RESULTS AND LIMITATIONS
Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (8% vs 7.5%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%).
CONCLUSIONS
While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%).
PATIENT SUMMARY
Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544.

Identifiants

DOI: 10.1016/j.euo.2021.03.004 PMID: 33846112 PMC: PMC9346635
pubmed: 33846112
pii: S2588-9311(21)00048-1
doi: 10.1016/j.euo.2021.03.004
pmc: PMC9346635
mid: NIHMS1688309
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT00102544']

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

176-186

Subventions

Organisme : Intramural NIH HHS
ID : Z01 BC011081
Pays : United States
Organisme : Intramural NIH HHS
ID : ZID BC011092
Pays : United States
Organisme : Intramural NIH HHS
ID : ZID BC011242
Pays : United States
Organisme : Intramural NIH HHS
ID : Z01 BC010655
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIA BC012062
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIE SC000853
Pays : United States

Informations de copyright

Published by Elsevier B.V.

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Auteurs

Michael Ahdoot (M)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: michael.ahdoot@cshs.org.

Amir H Lebastchi (AH)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Lori Long (L)

Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, Bethesda, MD, USA.

Andrew R Wilbur (AR)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Patrick T Gomella (PT)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Sherif Mehralivand (S)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Molecular Imaging Program, Center for Cancer Research, National Institute of Health, Bethesda, MD, USA.

Michael A Daneshvar (MA)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Nitin K Yerram (NK)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Luke P O'Connor (LP)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Alex Z Wang (AZ)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Sandeep Gurram (S)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Jonathan Bloom (J)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

M Minhaj Siddiqui (MM)

Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.

W Marston Linehan (WM)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Maria Merino (M)

Translational Surgical Pathology Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Peter L Choyke (PL)

Molecular Imaging Program, Center for Cancer Research, National Institute of Health, Bethesda, MD, USA.

Paul Pinsky (P)

Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Howard Parnes (H)

Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Joanna H Shih (JH)

Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, Bethesda, MD, USA.

Baris Turkbey (B)

Molecular Imaging Program, Center for Cancer Research, National Institute of Health, Bethesda, MD, USA.

Bradford J Wood (BJ)

Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Peter A Pinto (PA)

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

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