An Magnetic Resonance Imaging-directed Targeted-plus-perilesional Biopsy Approach for Prostate Cancer Diagnosis: "Less Is More"

Marinus J Hagens; M Arjen Noordzij; Jan Willem Mazel; Auke Jager; Thierry N Boellaard; Jeroen A W Tielbeek; Margot Henebiens; Ivo G Schoots; Pim J van Leeuwen; Henk G van der Poel; Sybren P Rynja

doi:10.1016/j.euros.2022.07.006

An Magnetic Resonance Imaging-directed Targeted-plus-perilesional Biopsy Approach for Prostate Cancer Diagnosis: "Less Is More"

Eur Urol Open Sci. 2022 Aug 2:43:68-73. doi: 10.1016/j.euros.2022.07.006. eCollection 2022 Sep.

Authors

Marinus J Hagens^{1

2

3}, M Arjen Noordzij^{3

4}, Jan Willem Mazel^{3

4}, Auke Jager^{1

3}, Thierry N Boellaard⁵, Jeroen A W Tielbeek⁶, Margot Henebiens⁶, Ivo G Schoots^{5

7}, Pim J van Leeuwen^{2

3}, Henk G van der Poel^{1

2

3}, Sybren P Rynja^{3

4}

Affiliations

¹ Department of Urology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
² Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands.
³ Prostate Cancer Network Netherlands, Amsterdam, The Netherlands.
⁴ Department of Urology, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands.
⁵ Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Amsterdam, The Netherlands.
⁶ Department of Radiology, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands.
⁷ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.

Abstract

Background: Considering that most men benefit diagnostically from increased sampling of index lesions, limiting systematic biopsy (SBx) to the region around the index lesion could potentially minimize overdetection while maintaining the detection of clinically significant prostate cancer (csPCa).

Objective: To evaluate the diagnostic performance of a hypothetical magnetic resonance imaging (MRI)-directed targeted-plus-perilesional biopsy approach.

Design setting and participants: This single-center, retrospective analysis of prospectively generated data included all biopsy-naïve men with unilateral MRI-positive lesions (Prostate Imaging Reporting and Data System category ≥3), undergoing both MRI-directed targeted biopsies and SBx. Grade group 2-5 cancers were considered csPCa.

Outcome measurements and statistical analysis: The diagnostic performance of a targeted-plus-perilesional biopsy approach was compared with that of a targeted-plus-systematic biopsy approach. The primary outcome was the detection of csPCa. Secondary outcomes included the detection of clinically insignificant prostate cancer (ciPCa) and the number of total biopsy cores.

Results and limitations: A total of 235 men were included in the analysis; csPCa and ciPCa were detected, respectively, in 95 (40.4%) and 86 (36.6%) of these 235 men. A targeted-plus-perilesional biopsy approach would have detected 92/95 (96.8%; 95% confidence interval [CI] 91.0-99.3%) csPCa cases. At the same time, detection of systematically found ciPCa would be reduced by 11/86 (12.8%; 95% CI 6.6-21.7%). If a targeted-plus-perilesional biopsy approach would have been performed, the number of biopsy cores per patient would have been reduced significantly (a mean difference of 5.2; 95% CI 4.9-5.6, p < 0.001).

Conclusions: An MRI-directed targeted-plus-perilesional biopsy approach detected almost all csPCa cases, while limiting overdiagnosis and reducing the number of biopsy cores. Prospective clinical trials are needed to substantiate the withholding of nonperilesional SBx in men with unilateral lesion(s) on MRI.

Patient summary: Limiting systematic biopsies to the proximity of the suspicious area on magnetic resonance imaging helps detect an equivalent number of aggressive cancers and fewer indolent cancers. These findings may help patients and physicians choose the best biopsy approach.

Keywords: Cognitive fusion; Perilesional systematic biopsies; Prostate biopsies; Transperineal.