PD57-10: Optimizing the Prostate Biopsy Template: Additional Value of Contralateral and Ipsilateral Systematic Biopsies in Patients with an Unilateral Lesion on Magnetic Resonance Imaging.
Monday, May 16, 2022
11:00 AM – 11:10 AM
Location: Room 245
Auke Jager*, Luigi van Riel, Arnoud Postema, Theo de Reijke, Tim van der Sluis, Jorg Oddens, Amsterdam, Netherlands
Introduction: The introduction of prostate MRI and MRI-targeted biopsy (TBx) has resulted in a discussion on what the optimal prostate biopsy template is. The ideal template has high sensitivity for clinically significant prostate cancer (csPCa), while reducing the detection rate of clinically insignificant prostate cancer (iPCa). This study evaluates different biopsy templates in patients with an unilateral MRI lesion
Methods: Retrospective analysis of a prospectively managed, multicenter cohort containing patients undergoing prostate biopsy. Patients with an unilateral lesion on MRI were included for analysis. The primary objective is to determine the csPCa (ISUP >1), adjusted csPCa (ISUP >2) and iPCa (ISUP 1) detection rates of contralateral systematic biopsy (SBx), ipsilateral SBx and TBx. A subgroup analysis was performed for biopsy naive patients.
Results: A total of 228 patients were included. PCa detection rate of SBx and TBx was 63.5% for csPCa, 35.5% for adjusted csPCa and 14% for iPCa. The best performing biopsy template was TBx and ipsilateral SBx, which reached sensitivity (95% CI) of 98.6% (95.1-99.6) for csPCa and 98.8% (96.3-99.9) for adjusted csPCa, missing only 1.4% of csPCa cases, while reducing iPCa detection by 15.6% compared to SBx and TBx. TBx or SBx alone missed a significant amount of csPCa, with sensitivities (95% CI) of 90,3% (84.4-94.2) and 86.8% (80.4-91.4) for csPCa. Subgroup analysis on biopsy naive patients had similar results to the overall group.
Conclusions: This study shows that performing TBx with ipsilateral SBx and omitting contralateral SBx is the optimal biopsy strategy in patients with an unilateral MRI lesion, missing a very small amount of csPCa, while reducing iPCa detection.
.jpg)
.jpg)