Session: MP40: Prostate Cancer: Detection & Screening I
MP40-08: Can we avoid systematic biopsies and do only targeted biopsies when there is a discernible lesion in MRI scan prostate with PIRADS scores 4 or 5? A single high volume centre retrospective data analysis
Introduction: Adopting an MRI first approach in prostate cancer diagnostic pathway has helped in decreasing the number of unnecessary prostate biopsies. Guidelines still recommend performing both targeted biopsy (TBx) and systematic biopsies (SBx) even when a lesion is detected in MRI. The prospect of doing only TBx if a definite lesion is seen in MRI is desirable as this decreases the morbidity of the procedure. However this has to be balanced against the risk of missing clinically significant prostate cancer (csPCa). We examined the data of our local anaesthetic transperineal (LATP) prostate biopsies, with MRI scan scores of PIRADS 4 & 5 and targetable lesion, and analysed the percentage of csPCa that would have been missed if only TBx were performed. Methods: We retrospectively collected the data of 650 patients who underwent LATP biopsies in our institute from February 2019 to July 2022. 329 patients had MRI score of PIRADS 4 or 5. All these patients had SBx and TBx according to the Ginsburg TP protocol. For MRI targetable lesions a four core cognitive guidance TBx was done per target. csPCa was defined as ISUP grade group 2 or more. Results: 329 patients had MRI score of PIRADS 4 or 5. 245 (74.5%) had targetable lesion and underwent both TBx and SBx. Both TBx and SBx were positive for csPCa in 39.6% (97/245). Both TBx and SBx didn’t show csPCa in 46.1% (113/245). In 5.7% (14/245), TBx showed csPCa when SBx was negative. In 8.6% (21/245), csPCa detected by SBx was missed by TBx. 15.9% (21/132) csPCa would have been missed if only TBx was performed for PIRADS 4 & 5 with an MRI targetable lesion. The sensitivity of TBx in this study was 82.2%, with specificity of 89.0% and a negative predictive value of 84.3%. Conclusions: his study from a high-volume centre suggests that adopting the TBx-only approach for MRI targetable lesions continues to miss a significant level of csPCa. Therefore adopting this strategy remains debatable SOURCE OF Funding: none
