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A clinical available decision support scheme for optimizing prostate biopsy based on mpMRI

Prostate Cancer and Prostatic Diseases volume 25, pages 727–734 (2022)Cite this article

Subjects

Abstract

Background

Combined MRI/Ultrasound fusion targeted biopsy (TBx) and systematic biopsy (SBx) results in better prostate cancer (PCa) detection relative to either TBx or SBx alone, while at the cost of higher number of biopsy cores and greater detection of clinically insignificant PCa. We therefore developed and evaluated a simple decision support scheme for optimizing prostate biopsy based on multiparametric (mp) MRI assessment.

Methods

Total 229 patients with suspicion of PCa underwent mpMRI before combined TBx/SBx were retrospectively included. Impacts of MRI characteristics such as Prostate Imaging-Reporting and Data System (PI-RADS) score, lesion size, zonal origination, and location on biopsy performance were evaluated. A clinically available decision support scheme relying on mpMRI assessment was subsequently developed as a triage test to optimize prostate biopsy process. Cost (downgrade, upgrade, and biopsy core)-to-Effectiveness (detection rate) was systemically compared.

Results

TBx achieved comparable detection rate to combined TBx/SBx in diagnosis of PCa and clinically significant PCa (csPCa) (PCa, 59% [135/229] vs 60.7% [139/229]; csPCa, 45.9% [105/229] vs 47.2% [108/229]; p-values > 0.05) and outperformed SBx (PCa, 42.4% [97/229]; csPCa, 28.4% [65/229]; p-values < 0.001). Specially, in personalized decision support scheme, TBx accurately detected all PCa (72.5% [74/102]) in PI-RADS 5 and larger (≥1 cm) PI-RADS 3-4 observations, adding SBx to TBx only resulted in 1.4% (1/74) upgrading csPCa. For smaller (<1 cm) PI-RADS 3-4 lesions, combined TBx/SBx resulted in relatively higher detection rate (51.2% [65/127] vs 48.0% [61/127]) and lower upgrading rate (30.6% [15/49] vs 36.7% [18/49]) than TBx.

Conclusions

The benefit of SBx added to TBx was largely restricted to smaller PI-RADS score 3–4 lesions. Using our personalized strategy of solo TBx for PI-RADS 5 and larger (≥1 cm) PI-RADS score 3–4 lesions would avoid excess SBx in 44.5% (102/229) of all biopsy-naïve patients without compromising detection rate.

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Fig. 1: Pairwise comparison of detection rates for PCa between TBx, SBx, and combined TBx/SBx.
Fig. 2: Impact of PI-RADS score on PCa detection rate with TBx, SBx, and TBx/SBx.
Fig. 3: Impact of lesion size on PCa detection rate with TBx, SBx, and TBx/SBx.
Fig. 4: Flowchart and evaluation of the proposed decision support scheme based on mpMRI assessment as a triage test to help urologist in optimizing prostate biopsy process.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding authors on reasonable request.

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Acknowledgements

This study was supported by the key research and development program of Jiangsu Province; contract grant number: BE2017756 (to YDZ).

Funding

Contract grant sponsor: Key research and development program of Jiangsu Province; contract grant number: BE2017756 (to YDZ).

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Author notes

  1. These authors contributed equally: Jin-Rong Qu, Gong Cheng and Yu-Dong Zhang.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

    Ying Hou, Ke-Wen Jiang, Jing Zhang, Hai-Bin Shi & Yu-Dong Zhang

  2. Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

    Mei-Ling Bao

  3. Department of urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

    Gong Cheng

  4. Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan Province, China

    Jin-Rong Qu

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Contributions

Study conception: YH, QJ, GC, YZ Data collection: YH, KJ, JZ, MB, HS, QJ, GC, YZ Data analysis: YH, KJ, JZ, MB, HS; QJ, GC, YZ Technical support: GC, YZ Administrative support: YZ Manuscript drafting: YH, KJ, JZ, MB, HS, Q.J, GC, YZ. All authors read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Jin-Rong Qu, Gong Cheng or Yu-Dong Zhang.

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The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

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Hou, Y., Jiang, KW., Zhang, J. et al. A clinical available decision support scheme for optimizing prostate biopsy based on mpMRI. Prostate Cancer Prostatic Dis 25, 727–734 (2022). https://doi.org/10.1038/s41391-021-00489-z

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