Added Value of Randomized Biopsy in Prostate Cancer Detection

What is it about?

This study aimed to investigate the added value of concurrent systematic randomized ultrasonography-guided biopsy (SBx) to multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy and the additional rate of overdiagnosis of clinically insignificant prostate cancer (ciPCa) by SBx in a large contemporary, real-world cohort. A total of 1552 patients with positive mpMRI and consecutive mpMRI-targeted biopsy and SBx were enrolled. The primary outcome was the detection rate of clinically significant prostate cancer (csPCa) by SBx, while mpMRI-targeted biopsy was negative or showed ciPCa. The secondary outcome was the rate of overdiagnosis by SBx, defined as the detection of ciPCa in patients with negative mpMRI-targeted biopsy and PSA level of <10 ng/mL. The detection rate of csPCa by mpMRI-targeted biopsy and/or SBx was 753/1552 (49%). The added value of SBx was 145/944 (15%). The rate of overdiagnosis by SBx was 146/656 (22%). The added value of SBx did not change when comparing patients with previous prostate biopsy and biopsy-naïve patients. In multivariable analysis, a Prostate Imaging-Reporting and Data System (PI-RADS) 4 index lesion (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.66-6.78; P = 0.001), a PI-RADS 5 index lesion (OR 2.89, 95% CI 1.39-6.46; P = 0.006) and age (OR 1.05, 95% CI 1.03-1.08; P < 0.001) were independently associated with added value of SBx. The study concluded that the added value of SBx is substantial and not to be neglected in any analysed risk group. The overall detection rate of csPCa of 49% in this real-world study is comparable to the detection rate of hallmark studies. [Some of the content on this page has been created by AI]

Featured Image

Why is it important?

This research is important because it provides valuable insights into the added value of concurrent systematic randomized ultrasonography-guided biopsy (SBx) in addition to multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy for the detection of clinically significant prostate cancer (csPCa) in a large, contemporary cohort. The study helps to understand the impact of SBx on the detection rate of csPCa and the rate of overdiagnosis of clinically insignificant prostate cancer (ciPCa) in a real-world setting, which is important for guiding clinical decision-making and patient management. Key Takeaways: 1. The addition of SBx to mpMRI-guided biopsy improves the overall detection rate but also increases the rate of overdiagnosis. 2. The study found a substantial added value of SBx in the detection of csPCa, with a rate of 15% in the study population. 3. The study did not identify any significant decrease in the added value of SBx across different risk groups, and thus, omitting SBx should not be considered in this setting. 4. Patients should be informed about the elevated risk of overdiagnosis by SBx.