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Ahdoot M, Lebastchi AH, Long L, et al. Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study. Eur Urol Oncol. 2021;doi: 10.1016/j.euo.2021.03.004.
Ahdoot, M., Lebastchi, A. H., Long, L., Wilbur, A. R., Gomella, P. T., Mehralivand, S., Daneshvar, M. A., Yerram, N. K., O'Connor, L. P., Wang, A. Z., Gurram, S., Bloom, J., Siddiqui, M. M., Linehan, W. M., Merino, M., Choyke, P. L., Pinsky, P., Parnes, H., Shih, J. H., Turkbey, B., Wood, B. J., Pinto, P. A. (2021). Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study. European urology oncology, . https://doi.org/10.1016/j.euo.2021.03.004
Ahdoot, Michael, et al. "Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study." European urology oncology vol. (2021). doi: https://doi.org/10.1016/j.euo.2021.03.004
Ahdoot M, Lebastchi AH, Long L, Wilbur AR, Gomella PT, Mehralivand S, Daneshvar MA, Yerram NK, O'Connor LP, Wang AZ, Gurram S, Bloom J, Siddiqui MM, Linehan WM, Merino M, Choyke PL, Pinsky P, Parnes H, Shih JH, Turkbey B, Wood BJ, Pinto PA. Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study. Eur Urol Oncol. 2021 Apr 10; doi: 10.1016/j.euo.2021.03.004. Epub 2021 Apr 10. PMID: 33846112.
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Eur Urol Oncol. 2021 Apr 10; doi: 10.1016/j.euo.2021.03.004. Epub 2021 Apr 10.

Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study.

European urology oncology

Michael Ahdoot, Amir H Lebastchi, Lori Long, Andrew R Wilbur, Patrick T Gomella, Sherif Mehralivand, Michael A Daneshvar, Nitin K Yerram, Luke P O'Connor, Alex Z Wang, Sandeep Gurram, Jonathan Bloom, M Minhaj Siddiqui, W Marston Linehan, Maria Merino, Peter L Choyke, Paul Pinsky, Howard Parnes, Joanna H Shih, Baris Turkbey, Bradford J Wood, Peter A Pinto,

Affiliations

  1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: [email protected].
  2. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
  3. Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, Bethesda, MD, USA.
  4. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Molecular Imaging Program, Center for Cancer Research, National Institute of Health, Bethesda, MD, USA.
  5. Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
  6. Translational Surgical Pathology Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
  7. Molecular Imaging Program, Center for Cancer Research, National Institute of Health, Bethesda, MD, USA.
  8. Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
  9. Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

PMID: 33846112 DOI: 10.1016/j.euo.2021.03.004

Abstract

BACKGROUND: While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa.

OBJECTIVE: To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC).

DESIGN, SETTING, AND PARTICIPANTS: Men with MRI-visible prostate lesions underwent combined TBx plus SBx.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score.

RESULTS AND LIMITATIONS: Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (7.5% vs 8%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%).

CONCLUSIONS: While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%).

PATIENT SUMMARY: Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544.

Published by Elsevier B.V.

Keywords: Combined biopsy; Fusion biopsy; Prostate Imaging-Reporting and Data System; Prostate cancer; Prostate cancer diagnosis; Prostate magnetic resonance imaging

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