- Perform mpMRI before prostate biopsy (1a, weak)
- When mpMRI is positive (ie. PI-RADS ≥3), combine targeted and systematic biopsies (2a, strong)
- When mpMRI is negative (ie. PI-RADS ≤2), and clinical suspicion of prostate cancer is low, omit biopsy based on shared decision making with the patient (2a, weak)
The aim of the current study was to compare mono-planar “fast” bpMRI, tri-planar bpMRI and mpMRI. This cohort was a subgroup of the 626 patients in the 4M prospective, multi-center, head-to-head trial3. The reference standard was the results of a systematic biopsy and in-bore MR-guided biopsy, as well as a PI-RADS score from the mpMRI (prior to fast bpMRI).
Dr. Barentsz group found that the fast bpMRI group had an 11% rate of PI-RADS 3 compared to 6% in the mpMRI group. Between the three arms (fast bpMRI, bpMRI, mpMRI), there was no difference in detection of clinically significant prostate cancer (sensitivity 95%); fast bpMRI resulted in a 2% increase in the number of men receiving a biopsy. Specificity was 69% in the mpMRI group and 66% in the fast bpMRI group.
Dr. Barentsz notes that there are several pros for fast bpMRI:
- The ability to perform 4 fast bpMRIs per hour
- There is a 54% decrease in direct costs, however, the total cost (secondary to increased biopsies and overdiagnosis) equalizes the cost savings
- There is no contrast given, thus eliminating the risk of an allergic reaction or Gadolinium-brain deposition
- A 5% absolute increase in PI-RADS 3 lesions (6% vs 11%); however, PRECISION  had 7%
- A 2% absolute increase in the number of biopsies (51% vs 53%)
- A 1% absolute increase in clinically insignificant prostate cancer (13% vs 12%); however, TRUS systematic biopsy has 23%
- No histology from mpMRI negative lesions
- The systematic biopsy as positive was the reference standard
- Expert center: limited generalizability
Presented by: Jelle Barentsz, MD, PhD, Radboudumc, Nijmegen, The Netherlands
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University - Medical College of Georgia Twitter: @zklaassen_md at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.
- Rouviere O, Renard-Penna R, Claudon M, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naïve patients (MRI-FIRST): A prospective, multicentre, paired diagnostic study. Lancet Oncol 2019 Jan;20(1):100-109.
- Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate cancer diagnosis. N Engl J Med 2018;378(19):1767-1777.
- van der Leest M, Cornel E, Israel B, et al. Head-to-head comparison of transrectal ultrasound-guided prostate versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: A Large Prospective multicenter study. Eur Urol. 2018 Nov 23 [Epub ahead of print].
Read the Discussion on this Presentation by Dr. Alberto Briganti