A diagnostic accuracy study of targeted and systematic biopsies to detect clinically significant prostate cancer, including a model for the partial omission of systematic biopsies

Morote, Juan; Picola, Natàlia; Muñoz-Rodríguez, Jesús; Paesano, Nahuel; Ruiz Plazas, Xavier; Muñoz-Rivero, Marta V.; Celma, Anna; García de Manuel, Gemma; Aisian, Ignacio; Servian, Pol; Abascal-Junquera, José María

doi:http://dx.doi.org/10.3390/cancers15184543

A diagnostic accuracy study of targeted and systematic biopsies to detect clinically significant prostate cancer, including a model for the partial omission of systematic biopsies

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Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, et al. A diagnostic accuracy study of targeted and systematic biopsies to detect clinically significant prostate cancer, including a model for the partial omission of systematic biopsies. Cancers (Basel). 2023 Sep 13;15(18):4543. DOI: 10.3390/cancers15184543

Abstract

The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721-0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.