The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy

Christophe K. Mannaerts (Corresponding author), Amir Kajtazovic, Olivia A.P. Lodeizen, Maudy Gayet, Marc R.W. Engelbrecht, Gerrit J. Jager, Hessel Wijkstra, Theo M. de Reijke, Harrie P. Beerlage

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Abstract

PURPOSE: Incorporation of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TBx) in the diagnostic pathway for prostate cancer (CaP) is rapidly becoming common practice. In men with a prebiopsy positive mpMRI a TBx only approach, thereby omitting transrectal ultrasound-guided systematic biopsy (SBx), has been postulated. In this study we evaluated the additional clinical relevance of SBx in men with a positive prebiopsy mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] ≥ 3) undergoing TBx for CaP detection, Gleason grading and CaP localization.

MATERIAL AND METHODS: Prospective data of 255 consecutive men with a prebiopsy positive mpMRI (PI-RADS ≥ 3) undergoing 12-core SBx and subsequent MRI-transrectal ultrasound fusion TBx in 2 institutions between 2015 and 2018 was obtained. The detection rate for significant CaP (Gleason score [GS] ≥ 3 + 4) for TBx and SBx were compared. The rate of potentially missed significant CaP by a TBx only approach was determined and GS concordance and CaP localization by TBx and SBx was evaluated.

RESULTS: TBx yielded significant CaP in 113 men (44%) while SBx yielded significant CaP in 110 men (43%) (P = 0.856). Insignificant CaP was found in 21 men (8%) by TBx, while SBx detected 34 men (13%) with insignificant CaP (P = 0.035). A TBx only approach, omitting SBx, would have missed significant CaP in 13 of the 126 men (10%) with significant CaP on biopsy. Ten of the 118 men (8%), both positive on TBx and SBx, were upgraded in GS by SBx while 11 men (9%) had higher maximum tumor core involvement on SBx. Nineteen of the 97 men (20%) with significant CaP in both TBx and SBx were diagnosed with unilateral significant CaP on mpMRI and TBx while SBx demonstrated bilateral significant CaP.

CONCLUSIONS: In men with a prebiopsy positive mpMRI, TBx detects high-GS CaP while reducing insignificant CaP detection as compared to SBx. SBx and TBx as stand-alone missed significant CaP in 13% and 10% of the men with significant CaP on biopsy, respectively. A combination of SBx and TBx remains necessary for the most accurate assessment of detection, grading, tumor core involvement, and localization of CaP.

Original languageEnglish
Pages (from-to)298.e1-298.e9
Number of pages9
JournalUrologic oncology
Volume37
Issue number5
Early online date16 Jan 2019
DOIs
Publication statusPublished - May 2019

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Prostatic Neoplasms
Biopsy
Neoplasm Grading
Magnetic Resonance Imaging
Information Systems
Prostate

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Mannaerts, C. K., Kajtazovic, A., Lodeizen, O. A. P., Gayet, M., Engelbrecht, M. R. W., Jager, G. J., ... Beerlage, H. P. (2019). The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy. Urologic oncology, 37(5), 298.e1-298.e9. https://doi.org/10.1016/j.urolonc.2019.01.005
Mannaerts, Christophe K. ; Kajtazovic, Amir ; Lodeizen, Olivia A.P. ; Gayet, Maudy ; Engelbrecht, Marc R.W. ; Jager, Gerrit J. ; Wijkstra, Hessel ; de Reijke, Theo M. ; Beerlage, Harrie P. / The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy. In: Urologic oncology. 2019 ; Vol. 37, No. 5. pp. 298.e1-298.e9.
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title = "The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy",
abstract = "PURPOSE: Incorporation of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TBx) in the diagnostic pathway for prostate cancer (CaP) is rapidly becoming common practice. In men with a prebiopsy positive mpMRI a TBx only approach, thereby omitting transrectal ultrasound-guided systematic biopsy (SBx), has been postulated. In this study we evaluated the additional clinical relevance of SBx in men with a positive prebiopsy mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] ≥ 3) undergoing TBx for CaP detection, Gleason grading and CaP localization.MATERIAL AND METHODS: Prospective data of 255 consecutive men with a prebiopsy positive mpMRI (PI-RADS ≥ 3) undergoing 12-core SBx and subsequent MRI-transrectal ultrasound fusion TBx in 2 institutions between 2015 and 2018 was obtained. The detection rate for significant CaP (Gleason score [GS] ≥ 3 + 4) for TBx and SBx were compared. The rate of potentially missed significant CaP by a TBx only approach was determined and GS concordance and CaP localization by TBx and SBx was evaluated.RESULTS: TBx yielded significant CaP in 113 men (44{\%}) while SBx yielded significant CaP in 110 men (43{\%}) (P = 0.856). Insignificant CaP was found in 21 men (8{\%}) by TBx, while SBx detected 34 men (13{\%}) with insignificant CaP (P = 0.035). A TBx only approach, omitting SBx, would have missed significant CaP in 13 of the 126 men (10{\%}) with significant CaP on biopsy. Ten of the 118 men (8{\%}), both positive on TBx and SBx, were upgraded in GS by SBx while 11 men (9{\%}) had higher maximum tumor core involvement on SBx. Nineteen of the 97 men (20{\%}) with significant CaP in both TBx and SBx were diagnosed with unilateral significant CaP on mpMRI and TBx while SBx demonstrated bilateral significant CaP.CONCLUSIONS: In men with a prebiopsy positive mpMRI, TBx detects high-GS CaP while reducing insignificant CaP detection as compared to SBx. SBx and TBx as stand-alone missed significant CaP in 13{\%} and 10{\%} of the men with significant CaP on biopsy, respectively. A combination of SBx and TBx remains necessary for the most accurate assessment of detection, grading, tumor core involvement, and localization of CaP.",
author = "Mannaerts, {Christophe K.} and Amir Kajtazovic and Lodeizen, {Olivia A.P.} and Maudy Gayet and Engelbrecht, {Marc R.W.} and Jager, {Gerrit J.} and Hessel Wijkstra and {de Reijke}, {Theo M.} and Beerlage, {Harrie P.}",
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doi = "10.1016/j.urolonc.2019.01.005",
language = "English",
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Mannaerts, CK, Kajtazovic, A, Lodeizen, OAP, Gayet, M, Engelbrecht, MRW, Jager, GJ, Wijkstra, H, de Reijke, TM & Beerlage, HP 2019, 'The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy', Urologic oncology, vol. 37, no. 5, pp. 298.e1-298.e9. https://doi.org/10.1016/j.urolonc.2019.01.005

The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy. / Mannaerts, Christophe K. (Corresponding author); Kajtazovic, Amir; Lodeizen, Olivia A.P.; Gayet, Maudy; Engelbrecht, Marc R.W.; Jager, Gerrit J.; Wijkstra, Hessel; de Reijke, Theo M.; Beerlage, Harrie P.

In: Urologic oncology, Vol. 37, No. 5, 05.2019, p. 298.e1-298.e9.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy

AU - Mannaerts, Christophe K.

AU - Kajtazovic, Amir

AU - Lodeizen, Olivia A.P.

AU - Gayet, Maudy

AU - Engelbrecht, Marc R.W.

AU - Jager, Gerrit J.

AU - Wijkstra, Hessel

AU - de Reijke, Theo M.

AU - Beerlage, Harrie P.

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019/5

Y1 - 2019/5

N2 - PURPOSE: Incorporation of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TBx) in the diagnostic pathway for prostate cancer (CaP) is rapidly becoming common practice. In men with a prebiopsy positive mpMRI a TBx only approach, thereby omitting transrectal ultrasound-guided systematic biopsy (SBx), has been postulated. In this study we evaluated the additional clinical relevance of SBx in men with a positive prebiopsy mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] ≥ 3) undergoing TBx for CaP detection, Gleason grading and CaP localization.MATERIAL AND METHODS: Prospective data of 255 consecutive men with a prebiopsy positive mpMRI (PI-RADS ≥ 3) undergoing 12-core SBx and subsequent MRI-transrectal ultrasound fusion TBx in 2 institutions between 2015 and 2018 was obtained. The detection rate for significant CaP (Gleason score [GS] ≥ 3 + 4) for TBx and SBx were compared. The rate of potentially missed significant CaP by a TBx only approach was determined and GS concordance and CaP localization by TBx and SBx was evaluated.RESULTS: TBx yielded significant CaP in 113 men (44%) while SBx yielded significant CaP in 110 men (43%) (P = 0.856). Insignificant CaP was found in 21 men (8%) by TBx, while SBx detected 34 men (13%) with insignificant CaP (P = 0.035). A TBx only approach, omitting SBx, would have missed significant CaP in 13 of the 126 men (10%) with significant CaP on biopsy. Ten of the 118 men (8%), both positive on TBx and SBx, were upgraded in GS by SBx while 11 men (9%) had higher maximum tumor core involvement on SBx. Nineteen of the 97 men (20%) with significant CaP in both TBx and SBx were diagnosed with unilateral significant CaP on mpMRI and TBx while SBx demonstrated bilateral significant CaP.CONCLUSIONS: In men with a prebiopsy positive mpMRI, TBx detects high-GS CaP while reducing insignificant CaP detection as compared to SBx. SBx and TBx as stand-alone missed significant CaP in 13% and 10% of the men with significant CaP on biopsy, respectively. A combination of SBx and TBx remains necessary for the most accurate assessment of detection, grading, tumor core involvement, and localization of CaP.

AB - PURPOSE: Incorporation of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TBx) in the diagnostic pathway for prostate cancer (CaP) is rapidly becoming common practice. In men with a prebiopsy positive mpMRI a TBx only approach, thereby omitting transrectal ultrasound-guided systematic biopsy (SBx), has been postulated. In this study we evaluated the additional clinical relevance of SBx in men with a positive prebiopsy mpMRI (Prostate Imaging Reporting and Data System [PI-RADS] ≥ 3) undergoing TBx for CaP detection, Gleason grading and CaP localization.MATERIAL AND METHODS: Prospective data of 255 consecutive men with a prebiopsy positive mpMRI (PI-RADS ≥ 3) undergoing 12-core SBx and subsequent MRI-transrectal ultrasound fusion TBx in 2 institutions between 2015 and 2018 was obtained. The detection rate for significant CaP (Gleason score [GS] ≥ 3 + 4) for TBx and SBx were compared. The rate of potentially missed significant CaP by a TBx only approach was determined and GS concordance and CaP localization by TBx and SBx was evaluated.RESULTS: TBx yielded significant CaP in 113 men (44%) while SBx yielded significant CaP in 110 men (43%) (P = 0.856). Insignificant CaP was found in 21 men (8%) by TBx, while SBx detected 34 men (13%) with insignificant CaP (P = 0.035). A TBx only approach, omitting SBx, would have missed significant CaP in 13 of the 126 men (10%) with significant CaP on biopsy. Ten of the 118 men (8%), both positive on TBx and SBx, were upgraded in GS by SBx while 11 men (9%) had higher maximum tumor core involvement on SBx. Nineteen of the 97 men (20%) with significant CaP in both TBx and SBx were diagnosed with unilateral significant CaP on mpMRI and TBx while SBx demonstrated bilateral significant CaP.CONCLUSIONS: In men with a prebiopsy positive mpMRI, TBx detects high-GS CaP while reducing insignificant CaP detection as compared to SBx. SBx and TBx as stand-alone missed significant CaP in 13% and 10% of the men with significant CaP on biopsy, respectively. A combination of SBx and TBx remains necessary for the most accurate assessment of detection, grading, tumor core involvement, and localization of CaP.

U2 - 10.1016/j.urolonc.2019.01.005

DO - 10.1016/j.urolonc.2019.01.005

M3 - Article

C2 - 30660493

VL - 37

SP - 298.e1-298.e9

JO - Urologic oncology

JF - Urologic oncology

SN - 1078-1439

IS - 5

ER -