The impact of a second MRI and re-biopsy in patients with initial negative mpMRI-targeted and systematic biopsy for PIRADS ≥ 3 lesions

• Published in: World journal of urology Vol. 41; no. 11; pp. 3357 - 3366
• Main Authors: Zattoni, Fabio, Pereira, Leonor J. Paulino, Marra, Giancarlo, Valerio, Massimo, Olivier, Jonathan, Puche-Sanz, Ignacio, Rajwa, Pawel, Maggi, Martina, Campi, Riccardo, Amparore, Daniele, De Cillis, Sabrina, Junlong, Zhuang, Guo, Hongqian, La Bombarda, Giulia, Fuschi, Andrea, Veccia, Alessandro, Ditonno, Francesco, Marquis, Alessandro, Barletta, Francesco, Leni, Riccardo, Serni, Sergio, Kasivisvanathan, Veeru, Antonelli, Alessandro, Dal Moro, Fabrizio, Rivas, Juan Gomez, van den Bergh, Roderick C. N., Briganti, Alberto, Gandaglia, Giorgio, Novara, Giacomo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2023; Springer Nature B.V
• Subjects: Biopsy; Humans; Image-Guided Biopsy; Lesions; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Multiparametric Magnetic Resonance Imaging; Nephrology; Oncology; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retrospective Studies; Tertiary Care Centers; Topic Paper; Urology; Targeted biopsy; Target prostate biopsy; Negative biopsy; Diagnosis prostate MRI; Prostate cancer
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-023-04578-7

Objective To evaluate the proportions of detected prostate cancer (PCa) and clinically significant PCa (csPCa), as well as identify clinical predictors of PCa, in patients with PI-RADS >  = 3 lesion at mpMRI and initial negative targeted and systematic biopsy (initial biopsy) who underwent a second MRI and a re-biopsy. Methods A total of 290 patients from 10 tertiary referral centers were included. The primary outcome measures were the presence of PCa and csPCa at re-biopsy. Logistic regression analyses were performed to evaluate predictors of PCa and csPCa, adjusting for relevant covariates. Results Forty-two percentage of patients exhibited the presence of a new lesion. Furthermore, at the second MRI, patients showed stable, upgrading, and downgrading PI-RADS lesions in 42%, 39%, and 19%, respectively. The interval from the initial to repeated mpMRI and from the initial to repeated biopsy was 16 mo (IQR 12–20) and 18 mo (IQR 12–21), respectively. One hundred and eight patients (37.2%) were diagnosed with PCa and 74 (25.5%) with csPCa at re-biopsy. The presence of ASAP on the initial biopsy strongly predicted the presence of PCa and csPCa at re-biopsy. Furthermore, PI-RADS scores at the first and second MRI and a higher number of systematic biopsy cores at first and second biopsy were independent predictors of the presence of PCa and csPCa. Selection bias cannot be ruled out. Conclusions Persistent PI-RADS ≥ 3 at the second MRI is suggestive of the presence of a not negligible proportion of csPca. These findings contribute to the refinement of risk stratification for men with initial negative MRI-TBx.