A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies

Author:

Morote Juan12,Picola Natàlia3,Muñoz-Rodriguez Jesús4,Paesano Nahuel5ORCID,Ruiz-Plazas Xavier6ORCID,Muñoz-Rivero Marta V.7,Celma Anna12,Manuel Gemma García-de8,Aisian Ignacio9,Servian Pol10,Abascal José M.1112ORCID

Affiliation:

1. Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain

2. Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain

3. Department of Urology, Hospital Universitari de Bellvitge, 08907 Hospitalet de Llobregat, Spain

4. Department of Urology, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain

5. Clínica Creu Blanca, 08034 Barcelona, Spain

6. Department of Urology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain

7. Department of Urology, Hospital Arnau de Vilanova, 25198 Lleida, Spain

8. Department of Urology, Hospital Universitari Josep Trueta, 17007 Girona, Spain

9. Department of Urology, Hospital Clinic, 08036 Barcelona, Spain

10. Department of Urology, Hospital Germans Trias i Pujol, 08916 Badalona, Spain

11. Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain

12. Department of Medicine and Health Science, Universitat Pompeu Fabra, 08003 Barcelona, Spain

Abstract

The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721–0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.

Funder

Instituto de Salut Carlos III

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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