Chad R Tracy1, Kevin J Flynn2, Daniel D Sjoberg3, Paul T Gellhaus2, Catherine M Metz4, Behfar Ehdaie5. 1. Department of Urology, University of Iowa Hospitals and Clinics: 3 Roy Carver Pavilion, 200 Hawkins Drive, Iowa City, IA 52242-1089; Department of Radiology, University of Iowa Hospitals and Clinics: 3970 John Pappajohn Pavilion, 200 Hawkins Drive, Iowa City, IA 52242-1089. Electronic address: Chad-tracy@uiowa.edu. 2. Department of Urology, University of Iowa Hospitals and Clinics: 3 Roy Carver Pavilion, 200 Hawkins Drive, Iowa City, IA 52242-1089. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. 4. Department of Radiology, University of Iowa Hospitals and Clinics: 3970 John Pappajohn Pavilion, 200 Hawkins Drive, Iowa City, IA 52242-1089. 5. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center: Memorial, Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
Abstract
INTRODUCTION: The optimal number of biopsy cores to obtain during MRI-targeted prostate biopsy remains ill-defined. This study sought to determine the optimal number of targeted biopsy cores to obtain from a region of interest to maximize detection of clinically significant prostate cancer. MATERIALS AND METHODS: Consecutive patients undergoing MRI-targeted prostate biopsy at a single institution that newly implemented a targeted biopsy pathway from May 2017 to February 2018 were prospectively enrolled. Five biopsy cores were obtained and individually analyzed from each region rated ≥3 on PI-RADS v2.0 to determine the incremental diagnostic benefit of each additional targeted biopsy core. Variables associated with increasing Grade Group from the first to fifth biopsy core were assessed. RESULTS: One hundred and four patients (79% for elevated PSA) were enrolled, 82% of which had a prior biopsy. Men with a PI-RADS >3 lesion were more likely to have pathologic upgrading with additional targeted biopsy cores (OR:4.76; 95% CI:2.34-9.70; P < 0.0001), particularly to Grade Group ≥2 (OR:5.16; 95% CI:2.17-12.29; P = 0.0002), compared to men with PI-RADS 3 lesions. Detection of clinically significant cancer increased from 26% to 44% to 52% when comparing the first, third, and fifth biopsy cores amongst men with a PI-RADS >3 lesion and from 1% to 4% to 9% for PI-RADS 3 lesions. Urinary retention was the most common complication, occurring in 6 (5.7%) patients. CONCLUSION: Clinically significant prostate cancer detection is improved with increased number of MRI-targeted biopsy cores, particularly for urologists early in their learning curve.
INTRODUCTION: The optimal number of biopsy cores to obtain during MRI-targeted prostate biopsy remains ill-defined. This study sought to determine the optimal number of targeted biopsy cores to obtain from a region of interest to maximize detection of clinically significant prostate cancer. MATERIALS AND METHODS: Consecutive patients undergoing MRI-targeted prostate biopsy at a single institution that newly implemented a targeted biopsy pathway from May 2017 to February 2018 were prospectively enrolled. Five biopsy cores were obtained and individually analyzed from each region rated ≥3 on PI-RADS v2.0 to determine the incremental diagnostic benefit of each additional targeted biopsy core. Variables associated with increasing Grade Group from the first to fifth biopsy core were assessed. RESULTS: One hundred and four patients (79% for elevated PSA) were enrolled, 82% of which had a prior biopsy. Men with a PI-RADS >3 lesion were more likely to have pathologic upgrading with additional targeted biopsy cores (OR:4.76; 95% CI:2.34-9.70; P < 0.0001), particularly to Grade Group ≥2 (OR:5.16; 95% CI:2.17-12.29; P = 0.0002), compared to men with PI-RADS 3 lesions. Detection of clinically significant cancer increased from 26% to 44% to 52% when comparing the first, third, and fifth biopsy cores amongst men with a PI-RADS >3 lesion and from 1% to 4% to 9% for PI-RADS 3 lesions. Urinary retention was the most common complication, occurring in 6 (5.7%) patients. CONCLUSION: Clinically significant prostate cancer detection is improved with increased number of MRI-targeted biopsy cores, particularly for urologists early in their learning curve.
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