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Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy?

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Date

2021-07-21

Authors

Gomez-Gomez, Enrique
Moreno Sorribas, Sara
Valero-Rosa, Jose
Blanca, Ana
Mesa, Juan
Salguero, Joseba
Carrasco-Valiente, Julia
Lopez-Ruiz, Daniel
Anglada-Curado, Francisco Jose

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MDPI
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Abstract

Our aim was to assess the value of adding standard biopsy to targeted biopsy in cases of suspicious multiparametric magnetic resonance imaging (mp-MRI) and also to evaluate when a biopsy of a PI-RADS 3 lesion could be avoided. A retrospective study of patients who underwent targeted biopsy plus standard systematic biopsy between 2016-2019 was performed. All the 1.5 T magnetic resonance images were evaluated according to PI-RADSv.2. An analysis focusing on the clinical scenario, lesion location, and PI-RADS score was performed. A total of 483 biopsies were evaluated. The mean age was 65 years, with a PSA density of 0.12 ng/mL/cc. One-hundred and two mp-MRIs were categorized as PI-RADS-3. Standard biopsy was most helpful in detecting clinically significant prostate cancer (csPCa) in patients in the active surveillance (AS) cohort (increasing the detection rate 12.2%), and in peripheral lesions (6.5%). Adding standard biopsy showed no increase in the detection rate for csPCa in patients with PI-RADS-5 lesions. Considering targeted biopsy in patients with PI-RADS 3 lesions, a higher detection rate was shown in biopsy-naïve patients versus AS and in patients with a previous negative biopsy (p = 0.002). Furthermore, in these patients, the highest rate of csPCa detection was in anterior lesions [42.9% (p = 0.067)]. Our results suggest that standard biopsy could be safely omitted in patients with anterior lesions and in those with PI-RADS-5 lesions. Targeted biopsy for PI-RADS-3 lesions would be less effective in peripheral lesions with a previous negative biopsy.

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MeSH Terms

Multiparametric Magnetic Resonance Imaging
Retrospective Studies
Prostate-Specific Antigen
Magnetic Resonance Imaging
Prostatic Neoplasms
Watchful Waiting
Biopsy

DeCS Terms

Antígeno prostático específico
Biopsia
Espera vigilante
Imagen por resonancia magnética
Imágenes de resonancia magnética Multiparamétrica
Neoplasias de la próstata

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Keywords

MRI targeted biopsy, PI-RADS 3 lesions, Prostate imaging reporting and data system (PI-RADS), Target-ing plus standard biopsy

Citation

Gomez-Gomez E, Moreno Sorribas S, Valero-Rosa J, Blanca A, Mesa J, Salguero J, et al. Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy? Diagnostics (Basel). 2021 Jul 26;11(8):1335