A Multicentre Study of the Clinical Utility of Non-targeted Systematic Transperineal Prostate Biopsies in Patients Undergoing Pre-biopsy mpMRI.

The added value of non-targeted systematic prostate biopsies (NT-PBx), when performed alongside MRI-targeted biopsies (T-PBx), in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal NT-Bx, when performed alongside T-Bx, using pre-biopsy multiparametric magnetic resonance imaging (mpMRI).

Consecutive patients referred with a suspicion of prostate cancer (April/2017-October/2019) underwent a pre-biopsy mpMRI. A transperineal biopsy was advised if mpMRI PI-RADS (v.2.0) score was 4 or 5; score 3 required a PSA-density >/=0.12ng/ml. Primary threshold for clinically significant prostate cancer (csPCa) was defined as any Gleason >/=3+4. Multivariable logistic regression analysis identified pre-biopsy predictors of csPCa in NT-PBx, irrespective of targeted-pathology (p<0.05; R.version:3.5.1).

1,719 men underwent a pre-biopsy mpMRI, with 679 (39.5%) proceeding to a combined T-PBx and NT-PBx. In these men, csPCa was detected in 333/679 (49%) and 139/679 (20.5%) with a T-PBx and NT-PBx, respectively. In those men with csPCa in T-PBx, csPCa was also present in NT-PBx in 117/679 (17.2%); Gleason 3+3 was present in 50/679 (7.4%). In 287 men without any cancer in the T-PBx, 13/679 (1.9%) had csPCa in NT-PBx; 18/679 (2.7%) had Gleason 3+3 disease; no Gleason >4+3 was detected. Predictors associated with csPCa in NT-PBx were: PSA >/=5ng/ml (OR 2.05; [95%CI 1.13-3.73]; p=0.02), PI-RADS score=5 (OR 2.26; 95%CI 1.51-3.38; p<0.001]) and prostate volume <50cc (OR 2.47, [95%CI 1.57-3.87]; p<0.001).

Detection of csPCa in exclusively non-targeted transperineal systematic biopsies in a pre-biopsy mpMRI pathway was low (1.9%).

The Journal of urology. 2020 Jun 09 [Epub ahead of print]

M J Connor, D Eldred-Evans, M van Son, F Hosking-Jervis, M Bertoncelli Tanaka, D Reddy, E Bass, L Powell, S Ahmad, E Pegers, S Joshi, D Sri, K Wong, H Tam, D Hrouda, H Qazi, S Gordon, M Winkler, H U Ahmed

Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom., Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands., Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom., Department of Urology, St. George's Hospital NHS Foundation Trust, London, United Kingdom., Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, United Kingdom., RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom.