MP58-01: Is MRI and fusion biopsies necessary in patients with PSA levels >10 ng/ml?

Lorenzo Maria Rovesti*, Riccardo Lombardo, Rome, Italy, Antonio Nacchia, Rionero in Vulture, Italy, Sara Riolo, Antonio Cicione, Beatrice Turchi, Giacomo Gallo, Carmen Gravina, Alessandro Guercio, Jordi Stira, Antonio Franco, Rome, Italy, Ferdinando Di Giacomo, Giuseppe Disabato, Rionero in Vulture, Italy, Giorgio Guarnotta, Elisa Mancini, Olivia Alessandra Voglino, Valeria Baldassarri, Simone D'Annunzio, Cosimo De Nunzio, Andrea Tubaro, Rome, Italy

Introduction: According to the latest EAU guidelines all patients should undergo MRI before  biopsy and subsequent fusion biopsies. The aim of our study is to evaluate the role of fusion biopsies in patients with high PSA levels.

Methods: From 2017 onwards, we consecutively enrolled, in 5 centers in Italy, men undergoing first 12 core trans-rectal ultrasound-guided prostate needle biopsy (SB) and first fusion biopsy (FB). Indications for prostate biopsy were a positive digital rectal examination (DRE), PSA=4ng/ml and/or positive MRI. All patients with PSA <10ng/ml or > 50 ng/ml were excluded from the analysis. Demographic, clinical and histopathological data were collected. Logistic regression analysis were used to evaluate predictors of cancer. A model was created for the prediction of cancer and LROC and decision curve analysis were used to assess discrimination, calibration and net benefit of the model with and without the Fusion variable.

Results: Overall 602 patients were enrolled with a median age of 68(61/73) years, median PSA of 6.6(4.7/9.9) ng/ml and a median prostate volume of 48(36/68) cc. Overall 350/602 (44%) presented prostate cancer (SB: 300/502: 60% vs FB:50/100:50%). On univariate analysis age, DRE, PSA, volume and fusion biopsies were independent predictors of cancer. On multivariate analysis age, DRE, PSA, volume were independent predictors of cancer while fusion biopsies did not reach the level of independent predictor. The accuracy of the cancer model was 0,73 without the fusion variable and 0,73 with the fusion variable. As well the decision curve analysis of both models did not differ.

Conclusions: In patients with PSA>10ng/ml fusion biopsies do not add any benefit. If our results are externally validated resources they may be better managed in countries were MRI or fusion is not always available.

Source of Funding: None