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Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies?

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Abstract

Purpose

The diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI.

Methods

A review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting.

Results

Evidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques.

Conclusion

A pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.

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References

  1. Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A et al (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? a systematic review of the literature. Eur Urol 68:1045–1053

    Article  PubMed  Google Scholar 

  2. Rastinehad AR, Turkbey B, Salami SS, Yaskiv O, George AK, Fakhoury M et al (2014) Improving detection of clinically significant prostate cancer: magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy. J Urol 191:1749–1754

    Article  PubMed  Google Scholar 

  3. Pokorny MR, de Rooij M, Duncan E, Schröder FH, Parkinson R, Barentsz JO et al (2014) Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. Eur Urol 66:22–29

    Article  PubMed  Google Scholar 

  4. Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L et al (2013) Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 63:125–140

    Article  PubMed  Google Scholar 

  5. Wegelin O, van Melick HHE, Hooft L, Bosch JLHR, Reitsma HB, Barentsz JO et al (2017) Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. Is there a preferred technique? Eur Urol 71:517–531

    Article  PubMed  Google Scholar 

  6. Moldovan PC, Van den Broeck T, Sylvester R, Marconi L, Bellmunt J, van den Bergh RCN et al (2017) What is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? A systematic review and meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. Eur Urol 72:250–266

    Article  PubMed  Google Scholar 

  7. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, PROMIS Study Group et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822

    Article  PubMed  Google Scholar 

  8. Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C et al (2016) Multiparametric magnetic resonance imaging (MRI) and MRI-transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen. Eur Urol 70:846–853

    Article  PubMed  Google Scholar 

  9. Le JD, Stephenson S, Brugger M, Lu DY, Lieu P, Sonn GA et al (2014) Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology. J Urol 192:1367–1373

    Article  PubMed  PubMed Central  Google Scholar 

  10. Le JD, Tan N, Shkolyar E, Lu DY, Kwan L, Marks LS et al (2015) Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology. Eur Urol 67:569–576

    Article  PubMed  Google Scholar 

  11. Delongchamps NB, Lefèvre A, Bouazza N, Beuvon F, Legman P, Cornud F (2015) Detection of significant prostate cancer with magnetic resonance targeted biopsies-should transrectal ultrasound-magnetic resonance imaging fusion guided biopsies alone be a standard of care? J Urol 193:1198–1204

    Article  PubMed  Google Scholar 

  12. Filson CP, Natarajan S, Margolis DJ, Huang J, Lieu P, Dorey FJ et al (2016) Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies. Cancer 122:884–892

    Article  PubMed  Google Scholar 

  13. Russo F, Regge D, Armando E, Giannini V, Vignati A, Mazzetti S et al (2016) Detection of prostate cancer index lesions with multiparametric magnetic resonance imaging (mp-MRI) using whole-mount histological sections as the reference standard. BJU Int 118:84–94

    Article  PubMed  Google Scholar 

  14. Martorana E, Pirola GM, Scialpi M, Micali S, Iseppi A, Bonetti LR et al (2017) Lesion volume predicts prostate cancer risk and aggressiveness: validation of its value alone and matched with prostate imaging reporting and data system score. BJU Int 120:92–103

    Article  CAS  PubMed  Google Scholar 

  15. Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N et al (2015) Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 313:390–397

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Siddiqui MM, George AK, Rubin R, Rais-Bahrami S, Parnes HL, Merino MJ et al (2016) Efficiency of prostate cancer diagnosis by MR/ultrasound fusion-guided biopsy vs standard extended-sextant biopsy for MR-visible lesions. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djw039

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tonttila PP, Lantto J, Pääkkö E, Piippo U, Kauppila S, Lammentausta E et al (2016) Prebiopsy multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naive men with suspected prostate cancer based on elevated prostate-specific antigen values: results from a randomized prospective blinded controlled trial. Eur Urol 69:419–425

    Article  PubMed  Google Scholar 

  18. Baco E, Rud E, Eri LM, Moen G, Vlatkovic L, Svindland A et al (2016) A randomized controlled trial to assess and compare the outcomes of two-core prostate biopsy guided by fused magnetic resonance and transrectal ultrasound images and traditional 12-core systematic biopsy. Eur Urol 69:149–156

    Article  PubMed  Google Scholar 

  19. Porpiglia F, Manfredi M, Mele F, Cossu M, Bollito E, Veltri A et al (2017) Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: results from a Randomized Prospective Study in biopsy-naïve patients with suspected prostate cancer. Eur Urol 72:282–288

    Article  PubMed  Google Scholar 

  20. Arsov C, Rabenalt R, Blondin D, Quentin M, Hiester A, Godehardt E et al (2015) Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol 68:713–720

    Article  PubMed  Google Scholar 

  21. Delongchamps NB, Portalez D, Bruguière E, Rouvière O, Malavaud B, Mozer P et al (2016) Are magnetic resonance imaging-transrectal ultrasound guided targeted biopsies noninferior to transrectal ultrasound guided systematic biopsies for the detection of prostate cancer? J Urol 196:1069–1075

    Article  PubMed  Google Scholar 

  22. Radtke JP, Kuru TH, Boxler S, Alt CD, Popeneciu IV, Huettenbrink C et al (2015) Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. J Urol 193:87–94

    Article  PubMed  Google Scholar 

  23. Schouten MG, van der Leest M, Pokorny M, Hoogenboom M, Barentsz JO, Thompson LC et al (2017) Why and where do we miss significant prostate cancer with multi-parametric magnetic resonance imaging followed by magnetic resonance-guided and transrectal ultrasound-guided biopsy in biopsy-naïve men? Eur Urol 71:896–903

    Article  PubMed  Google Scholar 

  24. Park BK, Park JW, Park SY, Kim CK, Lee HM, Jeon SS et al (2011) Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy. AJR Am J Roentgenol 197:876–881

    Article  Google Scholar 

  25. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. https://doi.org/10.1056/NEJMoa1801993

    Article  PubMed  Google Scholar 

  26. Cooper CS, Eeles R, Wedge DC, Van Loo P, Gundem G, Alexandrov LB et al (2015) Analysis of the genetic phylogeny of multifocal prostate cancer identifies multiple independent clonal expansions in neoplastic and morphologically normal prostate tissue. Nat Genet 47:367–372

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kamrava M, Hegde JV, Abgaryan N, Chang E, Le JD, Wang J et al (2016) Does the addition of targeted prostate biopsies to standard systemic biopsies influence treatment management for radiation oncologists? BJU Int 117:584–591

    Article  PubMed  Google Scholar 

  28. Mehralivand S, Shih JH, Rais-Bahrami S, Oto A, Bednarova S, Nix JW et al (2018) A magnetic resonance imaging-based prediction model for prostate biopsy risk stratification. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2017.5667

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gaziev G, Wadhwa K, Barrett T, Koo BC, Gallagher FA, Serrao E et al (2016) Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI-transrectal ultrasonography (TRUS) fusion-guided transperineal prostate biopsies as a validation tool. BJU Int 117:80–86

    Article  PubMed  Google Scholar 

  30. Venderink W, de Rooij M, Sedelaar JPM, Huisman HJ, Fütterer JJ (2016) Elastic versus rigid image registration in magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy: a systematic review and meta-analysis. Eur Urol Focus. https://doi.org/10.1016/j.euf.2016.07.003

    Article  PubMed  Google Scholar 

  31. Westhoff N, Siegel FP, Hausmann D, Polednik M, von Hardenberg J et al (2017) Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms. World J Urol 35:1015–1022

    Article  CAS  PubMed  Google Scholar 

  32. Cornud F, Roumiguié M, Barry de Longchamps N, Ploussard G, Bruguière E, Portalez D et al (2018) Precision matters in MR imaging-targeted prostate biopsies: evidence from a prospective study of cognitive and elastic fusion registration transrectal biopsies. Radiology. https://doi.org/10.1148/radiol.2017162916

    Article  PubMed  Google Scholar 

  33. Renard-Penna R, Rouvière O, Puech P, Borgogno C, Abbas L, Roy C et al (2016) Current practice and access to prostate MR imaging in France. Diagn Interv Imaging 97:1125–1129

    Article  CAS  PubMed  Google Scholar 

  34. Borghesi M, Ahmed H, Nam R, Schaeffer E, Schiavina R, Taneja S et al (2017) Complications after systematic, random, and image-guided prostate biopsy. Eur Urol 71:353–365

    Article  PubMed  Google Scholar 

  35. Panebianco V, Barchetti F, Sciarra A, Ciardi A, Indino EL, Papalia R et al (2015) Multiparametric magnetic resonance Imaging vs. standard care in men being evaluated for prostate cancer: a randomized study. Urol Oncol 33:17.e1–17.e.7

    Article  Google Scholar 

  36. Taverna G, Bozzini G, Grizzi F, Seveso M, Mandressi A, Balzarini L et al (2016) Endorectal multiparametric 3-tesla magnetic resonance imaging associated with systematic cognitive biopsies does not increase prostate cancer detection rate: a randomized prospective trial. World J Urol 34(6):797–803

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Urology, Saint Jean Languedoc/La Croix du Sud Hospital, 20, route de Revel, 31400, Toulouse, France

    Guillaume Ploussard

  2. Department of Urology, University Hospital of Mainz, Mainz, Germany

    Hendrik Borgmann & Igor Tsaur

  3. Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy

    Alberto Briganti & Giorgio Gandaglia

  4. Department of Radiology, Ghent University Hospital, Ghent, Belgium

    Pieter de Visschere

  5. Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands

    Jurgen J. Fütterer

  6. Department of Urology, University Hospital of Innsbrück, Innsbrück, Austria

    Isabel Heidegger

  7. Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany

    Alexander Kretschmer

  8. Department of Urology, CHU Rennes, Rennes, France

    Romain Mathieu

  9. Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium

    Piet Ost

  10. Department of Urology, University College London Hospital, London, UK

    Prasanna Sooriakumaran

  11. Department of Urology, Fundeni Clinical Institute, Bucharest, Romania

    Cristian Surcel

  12. Department of Urology, Martini Klinik, Hamburg, Germany

    Derya Tilki

  13. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Massimo Valerio

  14. Department of Urology, Antonius Hospital, Utrecht, The Netherlands

    Roderick van den Bergh

  15. IUCT-O, Avenue Joliot-Curie, 31000, Toulouse, France

    Guillaume Ploussard

Authors
  1. Guillaume Ploussard
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  2. Hendrik Borgmann
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  3. Alberto Briganti
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  6. Giorgio Gandaglia
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  7. Isabel Heidegger
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  15. Massimo Valerio
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  16. Roderick van den Bergh
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Consortia

EAU-YAU Prostate Cancer Working Group

Contributions

Guillaume Ploussard: Protocol/Project Development, Data collection, data writing. Hendrik Borgmann: Critical revision, editing. Alberto Briganti: Critical revision, editing. Pieter de Visschere: Critical revision, editing. Jurgen J. Fütterer: Critical revision, editing. Giorgio Gandaglia: Critical revision, editing. Isabel Heidegger: Critical revision, editing. Alexander Kretschmer: Critical revision, editing. Romain Mathieu: Critical revision, editing. Piet Ost: Critical revision, editing. Prasanna Sooriakumaran: Critical revision, editing. Cristian Surcel: Critical revision, editing. Derya Tilki: Critical revision, editing. Igor Tsaur: Critical revision, editing. Massimo Valerio: Critical revision, editing. Roderick van den Bergh: Protocol/Project Development, Data collection, data writing.

Corresponding author

Correspondence to Guillaume Ploussard.

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The authors declared that they have no conflict of interest.

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Ploussard, G., Borgmann, H., Briganti, A. et al. Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies?. World J Urol 37, 243–251 (2019). https://doi.org/10.1007/s00345-018-2399-z

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  • DOI: https://doi.org/10.1007/s00345-018-2399-z

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