Effect of information on prostate biopsy history on biopsy outcomes in the era of MRI-targeted biopsies

Anna Lantz, Erik Skaaheim Haug, Wolfgang Picker, Alessio Crippa, Fredrik Jäderling, Ashkan Mortezavi, Tobias Nordström, Anna Lantz, Erik Skaaheim Haug, Wolfgang Picker, Alessio Crippa, Fredrik Jäderling, Ashkan Mortezavi, Tobias Nordström

Abstract

Purpose: To describe the predictive value of information on previous benign biopsy for the outcome of MRI-targeted biopsies.

Methods: An exploratory analysis was conducted using data from a prospective, multicenter, paired diagnostic study of 532 men undergoing diagnostics for prostate cancer during 2016-2017. All men underwent 1.5 T MRI; systematic prostate biopsies; and MRI-targeted biopsies to MRI lesions with Prostate Imaging Reporting and Data System version 2, PI-RADS ≥ 3. The main outcome was numbers of detected prostate cancer characterized by grade group (GG) where GG ≥ 2 defined clinically significant cancer (csPCa).

Results: Men with previous biopsies had significantly more often negative MRI (26% vs. 17%, p < 0.05) compared to men without previous biopsies. Men with previous biopsies showed higher rates of benign biopsies (41% vs. 26%, p < 0.05) and lower rates of GG2 (17% vs. 30%, p < 0.05) and GG ≥ 3 (5% vs. 10%, p < 0.05) cancer. Biopsy-naïve men had higher proportions of highly suspicious MRI lesions (PIRADS 5; p < 0.05) and a higher proportion of significant cancer in those lesions (p = 0.05). In multivariate regression analysis, a previous benign prostate biopsy was associated with less than half the odds of csPCa (OR 0.38; 95% CI 0.20-0.71).

Conclusion: In this large prospective multicenter trial, we showed that men with a previous prostate biopsy had higher proportions of MRIs without lesions and lower proportion of highly suspicious lesions than biopsy-naïve men. Further, biopsy-naïve men showed higher detection of clinically significant cancer when using MRI-targeted biopsies. Also, in the era of MRI-targeted biopsy strategies, biopsy history should be carefully considered in biopsy decisions.

Trial registration: NCT02788825 (ClinicalTrials.gov). Date of registration June 2, 2016.

Keywords: MRI; Magnetic resonance imaging; Prostate biopsy; Prostate cancer; Prostate neoplasm; Targeted biopsy.

Conflict of interest statement

The authors declare that they have no conflict of interest.

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