Scientific Reports (Aug 2022)

Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy

  • Kira Kornienko,
  • Miriam Reuter,
  • Andreas Maxeiner,
  • Karsten Günzel,
  • Beatrice Kittner,
  • Maximilian Reimann,
  • Sebastian L. Hofbauer,
  • Laura E. Wiemer,
  • Robin Heckmann,
  • Patrick Asbach,
  • Johann Jakob Wendler,
  • Martin Schostak,
  • Thorsten Schlomm,
  • Frank Friedersdorff,
  • Hannes Cash

DOI
https://doi.org/10.1038/s41598-022-17260-6
Journal volume & issue
Vol. 12, no. 1
pp. 1 – 7

Abstract

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Abstract Magnetic resonance imaging/Ultrasound (MRI/US) fusion targeted biopsy (TB) in combination with a systematic biopsy (SB) improves cancer detection but limited data is available how to manage patients with a Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 4 lesion and a negative biopsy. We evaluate the real-world management and the rate of clinically significant Prostate Cancer (csPCa) during follow-up. 1546 patients with a multi-parametric MRI (mpMRI) and a PI-RADS ≥ 3 who underwent SB and TB between January 2012 and May 2017 were retrospectively analyzed. 222 men with a PI-RADS ≥ 4 and a negative biopsy were included until 2019. For 177/222 (80%) complete follow-up data was obtained. 66/84 (78%) had an initial PI-RADS 4 and 18 (22%) a PI-RADS 5 lesion. 48% (84/177) received a repeat mpMRI; in the follow-up mpMRI, 39/84 (46%) lesions were downgraded to PI-RADS 2 and 11 (13%) to PI-RADS 3; three cases were upgraded and 28 lesions remained consistent. 18% (32/177) men underwent repeated TB and csPCa was detected in 44% (14/32). Our study presents real world data on the management of men with a negative TB biopsy. Men with a positive mpMRI and lesions with high suspicion (PI-RADS4/5) and a negative targeted biopsy should be critically reviewed and considered for repeat biopsy or strict surveillance. The optimal clinical risk assessment remains to be further evaluated.