MP49-17 NECESSITY OF SYSTEMATIC BIOPSIES FOR PATIENTS WITH PI-RADS 5 LESIONS ON MULTIPARAMETRIC MRI

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP49)1 May 2024MP49-17 NECESSITY OF SYSTEMATIC BIOPSIES FOR PATIENTS WITH PI-RADS 5 LESIONS ON MULTIPARAMETRIC MRI Yuval Avda, Nachiketh Soodana-Prakash, Sunwoo Han, Isildinha Reis, Jamie Thomas, Jonathan T. Ryan, Bruno Nahar, Chad R. Ritch, Mark L. Gonzalgo, Dipen J. Parekh, and Sanoj Punnen Yuval AvdaYuval Avda , Nachiketh Soodana-PrakashNachiketh Soodana-Prakash , Sunwoo HanSunwoo Han , Isildinha ReisIsildinha Reis , Jamie ThomasJamie Thomas , Jonathan T. RyanJonathan T. Ryan , Bruno NaharBruno Nahar , Chad R. RitchChad R. Ritch , Mark L. GonzalgoMark L. Gonzalgo , Dipen J. ParekhDipen J. Parekh , and Sanoj PunnenSanoj Punnen View All Author Informationhttps://doi.org/10.1097/01.JU.0001008696.31772.28.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A combined approach of MRI-targeted biopsies (TB) and template systematic biopsies (SB) is routinely employed in multiparametric MRI (mpMRI) for enhanced prostate cancer detection. Some studies have suggested that Prostate Imaging Reporting & Data Systems (PI-RADS) 5 lesions may render SB unnecessary due to the low probability of missing clinically significant cancer in TB, but this data comes primarily from high-volume centers and does not consider missed risk-group upgrade in SB versus TB that could potentially impact management. METHODS: We identified patients with single PI-RADS 5 lesion in MRI-US fusion biopsy database who underwent both TB and SB. Patients with more than one lesion were excluded. We determined the highest Gleason Group (GG) from the TB and from the SB. The objective was to discern the potential number of missed clinically significant prostate cancers (GG≥2), risk-group upgrade (GG2 to GG≥3 and GG3 to GG≥4), if SB were not performed. Finally we analyzed for predictors of SB showing missed GG≥2 or GG upgrade. RESULTS: Our study comprised 386 patients with PI-RADS 5 lesions as described in Table 1. 259 (67.1%) patients exhibited GG≥2 in either TB or SB (Table 2). Should SB be excluded clinically significant cancers (GG≥2) would be missed in 39 (10.1%) patients, and risk group upgrade would go undetected in additional 30 (7.8%) patients. No variables were found to predict the risk of missing GG≥2 (Table 1). CONCLUSIONS: While some studies report a less than 5% chance of missing GG≥2 without SB in patients with PI-RADS 5 lesions, our findings show a considerably higher rate of missed clinically significant cancer (10.1%), or GG upgrade (7.8%), and suggest that SB avoidance could potentially change clinical management in 17.9% of patients. These findings require further validation, but we recommend that each institution conduct their own analysis prior to foregoing SB in men with PIRADS 5 lesions. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e789 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yuval Avda More articles by this author Nachiketh Soodana-Prakash More articles by this author Sunwoo Han More articles by this author Isildinha Reis More articles by this author Jamie Thomas More articles by this author Jonathan T. Ryan More articles by this author Bruno Nahar More articles by this author Chad R. Ritch More articles by this author Mark L. Gonzalgo More articles by this author Dipen J. Parekh More articles by this author Sanoj Punnen More articles by this author Expand All Advertisement PDF downloadLoading ...