Yield of second-round MRI targeted ultrasound-guided fusion prostate biopsy after initial first-round targeted biopsy
DOI:
https://doi.org/10.5489/cuaj.8366Keywords:
Prostate cancer; MRI; PRECISE; biopsyAbstract
INTRODUCTION: We aimed to determine the yield of second-round magnetic resonance imaging ultrasound (MRI-US) fusion biopsy and factors that may predict eventual clinically significant (cs) prostate cancer (PCa) diagnosis.
METHODS: From 2013–2021, 85 men underwent second-round MRI-US fusion biopsy of 92 lesions (47.8% [44/92] peripheral zone and 52.2% [48/92] transition zone). Patient age, prostate-specific antigen (PSA), PSA density (PSAD), size/location of lesions, apparent diffusion coefficient (ADC) value, Prostate Imaging-Reporting and Data System (PI-RADS), and PRECISE scores were recorded and compared to histopathologic diagnosis (International Society of Urological Pathology [ISUP] grade-group 1 PCa, csPCa=ISUP grade group ≥2 PCa) using logistic regression.
RESULTS: Mean patient age, PSA, and PSAD were 64±7 years, 8.5±7.0 ng/ml, and 0.17±0.11, respectively. Results from first-round targeted biopsy were 63% (58/92) negative and 37% (34/92) clinically insignificant (grade group 1) PCa. Overall, second-round targeted biopsy identified 25% (23/92) csPCa (grade group 2, n=19; grade group 3, n=4). Considering only lesions with initial negative targeted biopsy results (n=58), 21% (12/58; grade group 2, n=8; grade group 3, n=4) csPCa and 13 grade group 1 PCa were diagnosed at second-round biopsy. There was no difference in PSA (p=0.564), size (p=0.595), location (p=0.293), or PI-RADS score (p=0.342) of lesions by eventual csPCa diagnosis. PSAD (0.2±1.4 vs. 0.16±0.10, p=0.167), ADC (0.748±0.199 vs. 0.833±0.257, p=0.151), and PRECISE score (p<0.01) showed a trend towards association or association with eventual csPCa diagnosis.
CONCLUSIONS: Repeat second-round targeted MRI-US fusion biopsy yielded csPCa diagnosis in the targeted biopsy specimen in approximately 20% of patients in our study. PRECISE score may be a useful marker to help predict which patients require second-round biopsy.
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