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Comparison of biopsy strategies for prostate biopsy according to lesion size and PSA density in MRI-directed biopsy pathway

  • Special Section: Prostate cancer update
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Abstract

Purpose

To investigate whether the detection of clinically significant prostate cancer (csPCa) and the added value of focal saturation biopsy and systematic biopsy (SBx) differ according to index lesion size, and to compare the current guidelines for csPCa detection.

Methods

This retrospective study included consecutive men who underwent MRI and subsequent SBx and MRI-targeted biopsy (TBx) for a suspicious lesion between April 2019 and February 2020. Lesion visibility on transrectal ultrasound (US) and added value of focal saturation biopsy and SBx were compared according to index lesion size using chi-square and McNemar tests. csPCa detection rates and the proportion of biopsy-indicated men were compared among four biopsy strategies based on current guidelines.

Results

Of 313 men evaluated (median age, 65; interquartile range 60‒71), csPCa was detected in 110 (35%). In lesions < 10 mm, greater US invisibility (42.7% of lesions < 10 mm versus 20.0% of lesions ≥ 10 mm; p < 0.001) and higher added value of focal saturation biopsy and SBx (11.1% and 17.1% in lesions < 10 mm versus 4.2% and 6.3% in lesions ≥ 10 mm) were observed, compared with lesions ≥ 10 mm. Consideration of prostate-specific antigen (PSA) density > 0.15 ng/mL/mL as a cutoff in unsuspicious MRI led to a 14% reduction (44/313) in men who needed biopsy.

Conclusion

Determination of the biopsy strategy in terms of the need for focal saturation biopsy or SBx should be made considering lesion size. The use of PSA density in non-suspicious MRI can lead to a reduction in biopsy-indicated men.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Mi Yeon Park, Kye Jin Park, Mi-hyun Kim & Jeong Kon Kim

  2. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Bumjin Lim & In Gab Jeong

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  1. Mi Yeon Park
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Contributions

MYP: data analysis, literature review, investigation, KJP: Conceptualization, methodology, data analysis, writing, BL: data acquisition, investigation, literature review, MK: literature review, clinical studies, investigation, IGJ: literature review, editing, JKK editing, supervision.

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Correspondence to Kye Jin Park.

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This retrospective study was approved by our institutional review board, and a waiver for written informed consent was granted.

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Park, M.Y., Park, K.J., Lim, B. et al. Comparison of biopsy strategies for prostate biopsy according to lesion size and PSA density in MRI-directed biopsy pathway. Abdom Radiol 45, 4166–4177 (2020). https://doi.org/10.1007/s00261-020-02667-4

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  • DOI: https://doi.org/10.1007/s00261-020-02667-4

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