Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy

• Published in: Scientific reports Vol. 12; no. 1; pp. 13603 - 7
• Main Authors: Kornienko, Kira, Reuter, Miriam, Maxeiner, Andreas, Günzel, Karsten, Kittner, Beatrice, Reimann, Maximilian, Hofbauer, Sebastian L., Wiemer, Laura E., Heckmann, Robin, Asbach, Patrick, Wendler, Johann Jakob, Schostak, Martin, Schlomm, Thorsten, Friedersdorff, Frank, Cash, Hannes
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 10.08.2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308; 692/308/409; 692/4025; 692/4025/1752; 692/4025/2768/1753/466; Biopsy; Humanities and Social Sciences; Lesions; Magnetic resonance imaging; multidisciplinary; Patients; Prostate; Prostate cancer; Risk assessment; Science; Science (multidisciplinary); Ultrasonic imaging; Ultrasound
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-17260-6

Magnetic resonance imaging/Ultrasound ( MRI/US) fusion targeted biopsy (TB) in combination with a systematic biopsy (SB) improves cancer detection but limited data is available how to manage patients with a Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 4 lesion and a negative biopsy. We evaluate the real-world management and the rate of clinically significant Prostate Cancer (csPCa) during follow-up. 1546 patients with a multi-parametric MRI (mpMRI) and a PI-RADS ≥ 3 who underwent SB and TB between January 2012 and May 2017 were retrospectively analyzed. 222 men with a PI-RADS ≥ 4 and a negative biopsy were included until 2019. For 177/222 (80%) complete follow-up data was obtained. 66/84 (78%) had an initial PI-RADS 4 and 18 (22%) a PI-RADS 5 lesion. 48% (84/177) received a repeat mpMRI; in the follow-up mpMRI, 39/84 (46%) lesions were downgraded to PI-RADS 2 and 11 (13%) to PI-RADS 3; three cases were upgraded and 28 lesions remained consistent. 18% (32/177) men underwent repeated TB and csPCa was detected in 44% (14/32). Our study presents real world data on the management of men with a negative TB biopsy. Men with a positive mpMRI and lesions with high suspicion (PI-RADS4/5) and a negative targeted biopsy should be critically reviewed and considered for repeat biopsy or strict surveillance. The optimal clinical risk assessment remains to be further evaluated.