Session: PD39: Prostate Cancer: Detection & Screening V
PD39-07: Can we stop doing systematic biopsies in men with PIRADS/LIKERT 5 lesions on Multi Parametric Magnetic Resonance Imaging? An analysis from a multicentre prospective dataset of over 800 patients
Introduction: MRI-targeted biopsy has been demonstrated to be superior to systematic prostate biopsies in randomised studies. However there are few real-life multicentre prospective data evaluating cognitive targeted local anaesthetic transperineal prostate biopsy (CT-LATPB) outcomes and whether additional value is added by performing systematic biopsies. The South West Prostate Dashboard (SWPD) is largest prospective database of Local Anaesthetic Transperineal Prostate Biopsies in the United Kingdom. We investigated the outcomes of men with PIRADS/LIKERT 5 lesions on mpMRI who underwent CT-LATPB and systematic biopsies in the SWPD. Methods: Using the SWPD, we identified all men between January 2021 and June 2022 with a PIRADS/LIKERT 5 index lesion on their diagnostic mpMRI at 5 hospitals. We then compared the biopsy outcomes for targeted and systematic prostate biopsies in these men. Data in the SWPD registry is input from hospitals in the region prospectively by trained data inputters. Standardised mpMRI and pathology reporting was implemented prior to commencement of data entry. Results: A total of 3799 men underwent mpMRI prostate in the SWPD over the study period. Of these 808/3799 (21%) men, median age 69, were identified to have a PIRADS/LIKERT 5 lesion and 629/808 (78%) of the men with these lesions were under 75 years. The median PSA density of men with these lesions was over 0.21 in all centres and all men with a PIRADS/LIKERT 5 lesion underwent a prostate biopsy. The median number of prostate cores taken at targeted and systematic biopsy per individual was 15. No evidence of cancer was present in 5% of men biopsied. In the remainder of men the overall International Society of Urological Pathology (ISUP) Grade Group (GG) identified was GG1 (6%), GG2 (33%), GG3 (26%), GG4 (9%), GG5 (21%). Systematic core biopsies identified higher ISUP grade groups than the targeted core biopsies taken in the same men in 78/808 (9%). The upgrading effect would only have changed the clinical management of patients in 17/808 (2%). Conclusions: Prospective data collection supports the safe diagnosis of clinically significant prostate cancer in men with PIRADS/LIKERT 5 lesions with CT-LATP biopsy only with standardised reporting of mpMRI. Systematic biopsies need only be taken if non clinically significant disease is identified or focal therapy is being considered. This resource efficient patient focused approach is also more environmentally sustainable. SOURCE OF Funding: SWAG Cancer Alliance and Peninsula Cancer Alliance
