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?

Gomez-Gomez, EnriqueMoreno Sorribas, SaraValero-Rosa, JoseBlanca, AnaMesa, JuanSalguero, JosebaCarrasco-Valiente, JuliaLopez-Ruiz, DanielAnglada-Curado, Francisco Jose2023-02-092023-02-092021-07-21Gomez-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):13352075-4418http://hdl.handle.net/10668/18432Our 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.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/MRI targeted biopsyPI-RADS 3 lesionsProstate imaging reporting and data system (PI-RADS)Target-ing plus standard biopsyMultiparametric Magnetic Resonance ImagingRetrospective StudiesProstate-Specific AntigenMagnetic Resonance ImagingProstatic NeoplasmsWatchful WaitingBiopsyDoes 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?research article34441270open accessAntígeno prostático específicoBiopsiaEspera vigilanteImagen por resonancia magnéticaImágenes de resonancia magnética MultiparamétricaNeoplasias de la próstata10.3390/diagnostics11081335PMC8392157https://www.mdpi.com/2075-4418/11/8/1335/pdf?version=1627282444https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392157/pdf