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Evaluating the efficacy of a low-cost cognitive MRI-targeted prostate biopsy protocol: is there still a role for lower volume centers in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era?

  • Urology - Original Paper
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Abstract

Purpose

MRI-targeted biopsy has improved prostate biopsy yield. However, cost constraints have made it difficult for many institutions to implement the newer methods. We evaluated the performance of a low-cost cognitive-targeting biopsy protocol based on 1.5 T multiparametric MRI graded with Prostate Imaging Reporting and Data System (PI-RADS) version 2 to examine the role for these institutions moving forward.

Methods

Retrospective analysis of 251 consecutive patients with prostate-specific antigen (PSA) under 50 who underwent MRI and subsequent prostate biopsy at a single facility. In addition to systematic biopsy, targeted cores were obtained with cognitive recognition under ultrasound. A control group of 267 consecutive patients with PSA under 50 biopsied without prior MRI was analyzed.

Results

Prostate biopsy preceded by MRI had a significantly higher probability of detecting both prostate cancer (68.1% vs. 51.3%) and clinically significant prostate cancer (57.4% vs. 39.7%) (p values < 0.01). Combination of systematic and targeted biopsy outperformed either regimen alone. PSA density and PI-RADS score were identified as independent risk factors, and a proposed diagnostic model (PSA density ≥ 0.25 or PI-RADS score ≥ 4) showed sensitivity of 88.6%, specificity of 55%, PPV of 81.2%, NPV of 68.8%, and accuracy of 78.0%.

Conclusions

Both pre-biopsy MRI and cognitive-targeted biopsy contributed to improvement of cancer yield. Future alterations of possible benefit included increasing target cores per lesion, and combining PI-RADS score and PSA density as indicators for biopsy. Similar protocols may represent an on-going role for lower volume centers in the diagnosis of prostate cancer.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Innovative Cancer Therapy, The Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-Ku, Tokyo, 108-8639, Japan

    Yuta Takeshima

  2. Department of Urology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino, Tokyo, 180-8610, Japan

    Yoshinori Tanaka, Kotaro Takemura & Shusaku Nakazono

  3. Department of Radiology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino, Tokyo, 180-8610, Japan

    Eiko Yamashita

  4. Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan

    Haruki Kume

Authors
  1. Yuta Takeshima
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  2. Yoshinori Tanaka
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  3. Kotaro Takemura
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  4. Shusaku Nakazono
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Contributions

YuT was responsible for conception and design of the study, as well as acquisition and analysis of data, and drafted the manuscript. YoT oversaw the conception and design of the study, and supervised data acquisition and drafting of the manuscript. KT and SN contributed equally to YuT in the acquisition of data. EY served a primary role in interpretation of the data. HK provided supervision for the drafting of the manuscript, and a chief role in critical revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuta Takeshima.

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Conflict of interest

None declared.

Ethics approval

Approval of the institutional review board of the Institute of Medical Science, University of Tokyo (Approval no. 2019-2-0607), and Musashino Red Cross Hospital (Approval no. 1025).

Consent to participate/consent for publication

All patients whose data were retrospectively analyzed were informed of the use of their clinical information under anonymization, and received an opportunity to object to use or publication.

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Available from corresponding author upon reasonable request.

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Not applicable.

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Takeshima, Y., Tanaka, Y., Takemura, K. et al. Evaluating the efficacy of a low-cost cognitive MRI-targeted prostate biopsy protocol: is there still a role for lower volume centers in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era?. Int Urol Nephrol 52, 2043–2050 (2020). https://doi.org/10.1007/s11255-020-02533-8

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  • DOI: https://doi.org/10.1007/s11255-020-02533-8

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