Value of Contralateral Biopsies in Prostate Cancer Detection with Unilateral MRI Findings

What is it about?

This study evaluates the role of contralateral systematic biopsies in detecting clinically significant prostate cancer in men with unilateral suspicious findings on MRI. A cohort of 655 men undergoing MRI-guided transperineal biopsies was analyzed. Results revealed that only 1% of men had clinically significant prostate cancer detected exclusively through contralateral biopsies that were missed on MRI-targeted biopsy. Furthermore, 15% of men with cancer found through MRI-targeted biopsy also had matching cancer on contralateral biopsy, though this additional information rarely influenced treatment decisions. The findings suggest that contralateral systematic biopsies have limited utility in cancer detection or risk assessment for whole-gland treatments. However, they may provide value in evaluating cancer multifocality for focal therapy strategies. The study concludes that contralateral biopsies add minimal benefit in most cases and highlights the importance of refining biopsy strategies for more efficient prostate cancer detection.

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Photo by Accuray on Unsplash

Photo by Accuray on Unsplash

Why is it important?

This research is important because it evaluates the efficacy and clinical implications of performing contralateral systematic biopsies in men with unilateral suspicious MRI findings during MRI-guided transperineal biopsies. Understanding the value of these additional biopsies is crucial for optimizing prostate cancer detection and treatment strategies. The study's findings contribute to the ongoing debate about the necessity of systematic biopsies in the era of MRI-guided targeted biopsies, potentially leading to more refined and less invasive diagnostic procedures for prostate cancer. Key Takeaways: 1. Limited Value: Contralateral systematic biopsies in men with unilateral MRI findings have limited value for detecting clinically significant prostate cancer (csPCa) and assessing risk for whole-gland treatment, with only 1% of men having csPCa detected solely by contralateral biopsies. 2. Multifocality Assessment: While the additional biopsies may not significantly impact whole-gland treatment decisions, they could be important for determining prostate cancer multifocality, which is relevant when considering focal therapy eligibility. 3. Increased Detection of Insignificant Cancer: The study found that contralateral biopsies led to a two-fold increase in the detection of insignificant prostate cancer (Gleason Grade Group 1), potentially leading to overdiagnosis and unnecessary treatment in some cases.