Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy?
ABSTRACT Purpose Targeted biopsy (TB) combined with systematic biopsy (SB) is an optimized mode of prostate biopsy but can often lead to oversampling and overdiagnosis accompanied by potential biopsy-related complications and patient discomfort. Here, we attempted to reasonably stratify the patien...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Sociedade Brasileira de Urologia
2023-06-01
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| Series: | International Brazilian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382023000300359&lng=en&tlng=en |
| _version_ | 1797810357016723456 |
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| author | Zhengtong Lv Jinfu Wang Miao Wang Huimin Hou Liuqi Song Haodong Li Xuan Wang Ming Liu |
| author_facet | Zhengtong Lv Jinfu Wang Miao Wang Huimin Hou Liuqi Song Haodong Li Xuan Wang Ming Liu |
| author_sort | Zhengtong Lv |
| collection | DOAJ |
| description | ABSTRACT Purpose Targeted biopsy (TB) combined with systematic biopsy (SB) is an optimized mode of prostate biopsy but can often lead to oversampling and overdiagnosis accompanied by potential biopsy-related complications and patient discomfort. Here, we attempted to reasonably stratify the patient population based on multi-parameter indicators with the aim of avoiding unnecessary SB. Methods In total, 340 biopsy-naïve men with suspected lesions, prostate-specific antigen (PSA) < 20 ng/mL and prostate imaging-reporting and data system (PI-RADS) ≥ 3 enrolled for study underwent both TB and SB. The primary outcome was to determine independent predictors for a valid diagnosis, assuming that only TB was performed and SB omitted (defined as mono-TB), taking TB + SB as the reference standard. The secondary outcomes were exploration of the predictive factors of mono-TB and TB + SB in detection of prostate cancer (PCa) and clinically significant PCa (csPCa). Results The mean PSA density (PSAD) of patient group was 0.27 ng/mL/mL. Multiparametric MRI PI-RADS scores were 3-5 in 146 (42.94%), 105 (30.88%), and 89 (26.18%) cases, respectively. PCa and csPCa were detected in 178/340 (52.35%) and 162/340 (47.65%) patients, respectively. Overall, 116/178 (65.17%) patients diagnosed with PCa displayed pathological consistencies between mono-TB and TB + SB modes. PSAD and PI-RADS were independent predictors of valid diagnosis using mono-TB. Conclusions PSAD combined with PI-RADS showed utility in guiding optimization of the prostate biopsy mode. Higher PSAD and PI-RADS values were associated with greater confidence in implementing mono-TB and safely omitting SB, thus effectively balancing the benefits and risks. |
| first_indexed | 2024-03-13T07:07:33Z |
| format | Article |
| id | doaj.art-61d17323aae9414a9edeb4467adeeede |
| institution | Directory Open Access Journal |
| issn | 1677-6119 |
| language | English |
| last_indexed | 2024-03-13T07:07:33Z |
| publishDate | 2023-06-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj.art-61d17323aae9414a9edeb4467adeeede2023-06-06T07:36:03ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-61192023-06-0149335937110.1590/s1677-5538.ibju.2023.0060Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy?Zhengtong LvJinfu WangMiao WangHuimin HouLiuqi SongHaodong LiXuan Wanghttps://orcid.org/0000-0002-3556-3239Ming LiuABSTRACT Purpose Targeted biopsy (TB) combined with systematic biopsy (SB) is an optimized mode of prostate biopsy but can often lead to oversampling and overdiagnosis accompanied by potential biopsy-related complications and patient discomfort. Here, we attempted to reasonably stratify the patient population based on multi-parameter indicators with the aim of avoiding unnecessary SB. Methods In total, 340 biopsy-naïve men with suspected lesions, prostate-specific antigen (PSA) < 20 ng/mL and prostate imaging-reporting and data system (PI-RADS) ≥ 3 enrolled for study underwent both TB and SB. The primary outcome was to determine independent predictors for a valid diagnosis, assuming that only TB was performed and SB omitted (defined as mono-TB), taking TB + SB as the reference standard. The secondary outcomes were exploration of the predictive factors of mono-TB and TB + SB in detection of prostate cancer (PCa) and clinically significant PCa (csPCa). Results The mean PSA density (PSAD) of patient group was 0.27 ng/mL/mL. Multiparametric MRI PI-RADS scores were 3-5 in 146 (42.94%), 105 (30.88%), and 89 (26.18%) cases, respectively. PCa and csPCa were detected in 178/340 (52.35%) and 162/340 (47.65%) patients, respectively. Overall, 116/178 (65.17%) patients diagnosed with PCa displayed pathological consistencies between mono-TB and TB + SB modes. PSAD and PI-RADS were independent predictors of valid diagnosis using mono-TB. Conclusions PSAD combined with PI-RADS showed utility in guiding optimization of the prostate biopsy mode. Higher PSAD and PI-RADS values were associated with greater confidence in implementing mono-TB and safely omitting SB, thus effectively balancing the benefits and risks.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382023000300359&lng=en&tlng=enProstatic NeoplasmsProstateMagnetic Resonance Imaging |
| spellingShingle | Zhengtong Lv Jinfu Wang Miao Wang Huimin Hou Liuqi Song Haodong Li Xuan Wang Ming Liu Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy? International Brazilian Journal of Urology Prostatic Neoplasms Prostate Magnetic Resonance Imaging |
| title | Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy? |
| title_full | Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy? |
| title_fullStr | Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy? |
| title_full_unstemmed | Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy? |
| title_short | Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy? |
| title_sort | is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of mri trus fusion targeted biopsy |
| topic | Prostatic Neoplasms Prostate Magnetic Resonance Imaging |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382023000300359&lng=en&tlng=en |
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