Presentation Authors: Grace Yaguchi, Mustafa Deebajah*, Sean Williamson, Nilesh Gupta, Milan Pantelic, Hakmin Park, James Peabody, Mani Menon, Shaheen Alanee, Ali Dabaja, Detroit, MI
Introduction: The risk of transrectal prostate biopsy associated infection increases with number of cores taken. Our objective was to assess the need for systemic 12-core biopsy concurrent with MRI targeted biopsy (TB) of PI-RADS 4 and 5 regions of interest in patients with previous negative biopsy and rising prostate specific antigen, or positive prostate biopsy in candidates for active surveillance.
Methods: Retrospective analysis of a single institution. Prostate Lesions were graded on mpMRI by a single Fellowship trained radiology group. Pathology was reviewed by a fellowship trained GU pathologist, all patient underwent a MRI-TB and concurrent systemic 12-core biopsy by one urologist. An upgrade was defined as cancer detected in a patient with no previous prostate biopsy or increase in the GS from any previous biopsy.
Results: A total of 112 patients underwent an MRI-TB. There were 65 patients that had an upgrade of their prostate cancer after the TB and concurrent systemic 12 core biopsy (58%). Upgrade occurred in 53 of the 68 men based on the TB of the lesion (82.5%), 38 patients upgraded by the 12-core TRUS biopsy (60.3%). There were 27 patients upgraded on both the targeted lesion biopsy and the 12-core biopsy. On sub analysis 22 men had a PI-RADS 5 lesion(s). CDR was 21/22 patients (95.5%). The PI-RADS 5 lesions had an upgrade cancer detection rate of 90.5% (19/21 patients with cancer detected. 43 men had a PI-RADS 4 lesion(s), CDR was 33/43 patients (76.7%). PI-RADS 4 lesions had an upgrade cancer detection rate of 81.8% (27/33 patients with cancer detected). The 12-core systemic biopsy had a false negative rate of 39.3%. The biopsies of MRI targeted lesions of interest in total had a false negative rate of 17.5% compared to 9.5% false negative rate of PI-RADS 5 targeted lesions and 18.2% false negative rate of PI-RADS 4 targeted lesions.
Conclusions: Currently systemic biopsies are recommended in conjunction with MRI targeted lesion in all men with a clinically significant lesion. The false negative rate for upgrade in a PIRAD-5 lesion is very low. Men with a PI-RADS 5 lesion may have a similar CDR and upgrade with targeted biopsy of the lesion alone without a concurrent systemic 12-core sampling.