Presented by: Ahmad Alzubaidi M.D.
Penn State Health

Introduction

mpMRI targeted prostate biopsy improves detection of clinically significant cancer (CSC; Grade Group ≥ 2). Continued refinements in predicting pre-biopsy probability of CSC are essential for optimal patient counseling. We investigated potential factors related to improved cancer detection rates (CDR) of CSC in patients with PIRADS ≥ 3 lesions.

Materials

The pathology of 980 index lesions of patients who underwent transrectal mpMRI targeted prostate biopsy across 4 academic centers between 2017- 2020 was reviewed. PIRADS lesion distribution included 291 PIRADS-5, 374 PIRADS-4, and 315 PIRADS-3. Patients with index lesions within the anterior fibromuscular stroma (n=74) were excluded due to low numbers. We compared CDR of PIRADS ≥ 3 lesions based on location (transitional zone (TZ) vs peripheral zone (PZ)), PSA density (cutoff of 0.15 ng/mL/cm3 ) and history of prior negative conventional TRUS biopsy

Results

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Median patient age, PSA, and prostate volume was 66 years (43-90), 7.82 mg/dl (0.2-277), and 54 cm3 (12-173), respectively. For PIRADS-5, PIRADS-4, and PIRADS-3 lesions, CSC was detected in 164 patients (56%), 133 patients (36%), and 49 patients (16%), respectively. Notably, higher PSA density, no prior history of TRUS biopsy and PZ lesions were associated with higher CDR (Figure). CDR stratified across the factors of interest highlights significant variance across subgroups. For example, CDR for PIRADS-5, PZ lesions in patients with PSAD ≥ 0.15 and prior negative biopsy

Conclusion

For patients undergoing MRI targeted biopsy of PIRADS ≥3 lesions, CDR varied significantly based on location, prior history of negative TRUS biopsy and PSA density. Such considerations are critical for patient counseling when evaluating the merits and potential yield of mpMRI targeted biopsy

Funding

None

Co-Authors

Xuanjia Fan, BS
Penn State Health

Mo Said, MD
University of Iowa

R. Grant Owens, MD
Penn State Health

Michael Maidaa, MD
University of Florida

Suraj Pursnani, MD
Penn State Health

Scott Owens, MD
UPMC

Thomas Stringer, MD
University of Florida

Chad Tracy, MD
University of Iowa

Jay Raman, MD
Penn State Health