Prostate Cancer Risk Assessment in Biopsy-naïve Patients: The Rotterdam Prostate Cancer Risk Calculator in Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound (TRUS) Fusion Biopsy and Systematic TRUS Biopsy.

The value of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TBx) remains controversial for biopsy-naïve men when compared to transrectal ultrasound (TRUS)-guided systematic biopsy (SBx). Risk-based patient selection could help to selectively identify men with significant prostate cancer (PCa) and thus reduce unnecessary mpMRI and biopsies.

To compare PCa detection rates for mpMRI TBx with SBx and to determine the rate of potentially avoided mpMRI and biopsies through risk-based selection using the Rotterdam Prostate Cancer Risk Calculator (RPCRC).

Two-hundred consecutive biopsy-naïve men in two centres underwent mpMRI scanning, 12-core SBx, and subsequent MRI-TRUS TBx in the case of suspicious lesion(s) (Prostate Imaging-Reporting and Data System v.2 score ≥3).

We measured the detection rate for high-grade (Gleason score ≥ 3+4) PCa for TBx and SBx. We carried out a retrospective stratification according to RPCRC biopsy advice to determine the rate of mpMRI and biopsies that could potentially be avoided by RPCRC-based patient selection in relation to the rate of high-grade PCa missed.

TBx yielded high-grade PCa in 51 men (26%) and low-grade PCa in 14 men (7%), while SBx yielded high-grade PCa in 63 men (32%) and low-grade PCa in 41 men (21%). Four out of 73 men (5%) with negative RPCRC advice and 63 out of 127 men (50%) with positive advice had high-grade PCa. Upfront RPCRC-based patient selection for mpMRI and TBx would have avoided 73 out of 200 (37%) mpMRI scans, missing two out of 51 (4%) high-grade PCas. Limitations include the RPCRC definition of high- and low-grade PCa and different mpMRI techniques.

mpMRI with TBx detected PCa with high Gleason score and avoided biopsy in low-grade PCa, but failed to detect all high-grade PCa when compared to SBx among biopsy-naïve men. Risk-based patient selection using the RPCRC can avoid one-third of mpMRI scans and SBx in biopsy-naïve men.

Men with a suspicion of prostate cancer are increasingly undergoing a magnetic resonance imaging (MRI) scan. Although promising, MRI-targeted biopsy is not accurate enough to safely replace systematic prostate biopsy for now. Individualised assessment of prostate cancer risk using the Rotterdam Prostate Cancer Risk Calculator could avoid one-third of MRI scans and systematic prostate biopsies.

European urology oncology. 2018 May 15 [Epub]

Christophe K Mannaerts, Maudy Gayet, Jan F Verbeek, Marc R W Engelbrecht, C Dilara Savci-Heijink, Gerrit J Jager, Maaike P M Gielens, Hans van der Linden, Harrie P Beerlage, Theo M de Reijke, Hessel Wijkstra, Monique J Roobol

Department of Urology, AMC University Hospital, Amsterdam, The Netherlands. Electronic address: ., Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands., Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands., Department of Radiology, AMC University Hospital, Amsterdam, The Netherlands., Department of Pathology, AMC University Hospital, Amsterdam, The Netherlands., Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands., Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands., Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands., Department of Urology, AMC University Hospital, Amsterdam, The Netherlands., Department of Urology, AMC University Hospital, Amsterdam, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.