Effect of information on prostate biopsy history on biopsy outcomes in the era of MRI-targeted biopsies.

To describe the predictive value of information on previous benign biopsy for the outcome of MRI-targeted biopsies.

An exploratory analysis was conducted using data from a prospective, multicenter, paired diagnostic study of 532 men undergoing diagnostics for prostate cancer during 2016-2017. All men underwent 1.5 T MRI; systematic prostate biopsies; and MRI-targeted biopsies to MRI lesions with Prostate Imaging Reporting and Data System version 2, PI-RADS ≥ 3. The main outcome was numbers of detected prostate cancer characterized by grade group (GG) where GG ≥ 2 defined clinically significant cancer (csPCa).

Men with previous biopsies had significantly more often negative MRI (26% vs. 17%, p < 0.05) compared to men without previous biopsies. Men with previous biopsies showed higher rates of benign biopsies (41% vs. 26%, p < 0.05) and lower rates of GG2 (17% vs. 30%, p < 0.05) and GG ≥ 3 (5% vs. 10%, p < 0.05) cancer. Biopsy-naïve men had higher proportions of highly suspicious MRI lesions (PIRADS 5; p < 0.05) and a higher proportion of significant cancer in those lesions (p = 0.05). In multivariate regression analysis, a previous benign prostate biopsy was associated with less than half the odds of csPCa (OR 0.38; 95% CI 0.20-0.71).

In this large prospective multicenter trial, we showed that men with a previous prostate biopsy had higher proportions of MRIs without lesions and lower proportion of highly suspicious lesions than biopsy-naïve men. Further, biopsy-naïve men showed higher detection of clinically significant cancer when using MRI-targeted biopsies. Also, in the era of MRI-targeted biopsy strategies, biopsy history should be carefully considered in biopsy decisions.

NCT02788825 (ClinicalTrials.gov). Date of registration June 2, 2016.

World journal of urology. 2020 May 29 [Epub ahead of print]

Anna Lantz, Erik Skaaheim Haug, Wolfgang Picker, Alessio Crippa, Fredrik Jäderling, Ashkan Mortezavi, Tobias Nordström

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-171 77, Stockholm, Sweden. ., Section of Urology, Vestfold Hospital Trust, Tønsberg, Norway., Department of Radiology, Aleris Cancer Center, Oslo, Norway., Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-171 77, Stockholm, Sweden., Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.