Application of the PRECISION Trial Biopsy Strategy to a Contemporary Magnetic Resonance Imaging-Targeted Biopsy Cohort—How Many Clinically Significant Prostate Cancers are Missed?

No AccessJournal of UrologyAdult Urology1 Mar 2021Application of the PRECISION Trial Biopsy Strategy to a Contemporary Magnetic Resonance Imaging-Targeted Biopsy Cohort—How Many Clinically Significant Prostate Cancers are Missed?This article is commented on by the following:Editorial Comment Zachary Feuer, Xiaosong Meng, Andrew B. Rosenkrantz, Veeru Kasivisvanathan, Caroline M. Moore, Richard Huang, Fang-Ming Deng, Herbert Lepor, James S. Wysock, William C. Huang, and Samir S. Taneja Zachary FeuerZachary Feuer Department of Urology, NYU Langone Health, New York, New York More articles by this author , Xiaosong MengXiaosong Meng Department of Urology, NYU Langone Health, New York, New York More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz Department of Radiology, NYU Langone Health, New York, New York More articles by this author , Veeru KasivisvanathanVeeru Kasivisvanathan Division of Surgery and Interventional Science, University College of London, London, United Kingdom Financial and/or other relationship with the European Association of Urology. More articles by this author , Caroline M. MooreCaroline M. Moore Division of Surgery and Interventional Science, University College of London, London, United Kingdom Financial and/or other relationship with SonaCare, Janssen, Astellas and SpectraCure. More articles by this author , Richard HuangRichard Huang Department of Urology, NYU Langone Health, New York, New York More articles by this author , Fang-Ming DengFang-Ming Deng Department of Pathology, NYU Langone Health, New York, New York More articles by this author , Herbert LeporHerbert Lepor Department of Urology, NYU Langone Health, New York, New York More articles by this author , James S. WysockJames S. Wysock Department of Urology, NYU Langone Health, New York, New York More articles by this author , William C. HuangWilliam C. Huang Department of Urology, NYU Langone Health, New York, New York More articles by this author , and Samir S. TanejaSamir S. Taneja ‡Correspondence: Department of Urology, NYU Langone Health, 222 E. 41st Street, 12th Floor, New York, New York 10017 telephone: 201-790-4442; FAX: 646-825-6399). Department of Urology, NYU Langone Health, New York, New York Department of Radiology, NYU Langone Health, New York, New York Financial and/or other relationship with Trod Medical, Francis Medical, Insightec, Janssen, MDX Health and Elsevier. More articles by this author and PRECISION Study Collaborators View All Author Informationhttps://doi.org/10.1097/JU.0000000000001406AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: To demonstrate the generalizability of PRECISION findings and apply the PRECISION biopsy strategy to a contemporary cohort to characterize cancers missed by employing this strategy. Materials and Methods: A total of 629 men biopsied between February 2015 and September 2018 met PRECISION inclusion criteria. Men with PI-RADS™ 1-2 magnetic resonance imaging were only biopsied if high clinical suspicion for cancer. Missed cancers were defined as prostate cancer identified uniquely on systematic biopsy in men with PI-RADS 3-5 magnetic resonance imaging, or on either systematic biopsy or magnetic resonance imaging-targeted prostate biopsy in men with PI-RADS 1-2 magnetic resonance imaging. Outcomes included 1) clinically significant prostate cancer, Gleason grade group 2 or greater, detection rate, 2) missed clinically significant prostate cancer rate upon application of PRECISION biopsy strategy, 3) Gleason grade group distribution, core size, spatial orientation and oncologic risk among missed cancers. Results: Application of the PRECISION biopsy strategy to the study cohort resulted in avoidance of biopsy in 28%, similar magnetic resonance imaging-targeted prostate biopsy detection rate to PRECISION, reduction of Gleason grade group 1 detection rate by 60% and reduction of clinically significant prostate cancer detection rate by 19%. Missed clinically significant prostate cancers were often smaller than 6 mm (54.5%), Gleason grade group 2 (67.3%) and low risk by clinical nomogram (74.6%). Gleason grade group 1 cancers identified uniquely on systematic biopsy were often contralateral to magnetic resonance imaging target (46.4%), while missed clinically significant prostate cancer was predominantly ipsilateral (81%). Limitations include biopsy of only men with high risk clinical features among PI-RADS 1-2 magnetic resonance imaging, potentially overestimating the clinically significant prostate cancer detection rate. Conclusions: The study cohort demonstrated generalizability of PRECISION findings. Applying the PRECISION biopsy strategy greatly reduces Gleason grade group 1 detection rate, while missing a small number of clinically significant prostate cancer, typically small volume, low risk, and Gleason grade group 2. Missed clinically significant prostate cancer is predominantly ipsilateral to magnetic resonance imaging target, possibly representing targeting error. References 1. : Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015; 313: 390. Google Scholar 2. : Relationship between prebiopsy multiparametric magnetic resonance imaging (MRI), biopsy indication, and MRI-ultrasound fusion-targeted prostate biopsy outcomes. Eur Urol 2016; 69: 512. Google Scholar 3. : Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies. Cancer 2016; 122: 884. Google Scholar 4. : Long-term psychological and quality-of life effects of active surveillance and watchful waiting after diagnosis of low-risk localised prostate cancer. Eur Urol 2018; 73: 859. Google Scholar 5. : Update of the AUA policy statement on the use of multiparametric magnetic resonance imaging in the diagnosis, staging and management of prostate cancer. J Urol 2020; 203: 706. Link, Google Scholar 6. : EAU - EANM - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer 2019. Arnhem, The Netherlands: European Association of Urology. Available at https://uroweb.org/wp-content/uploads/EAU-EANM-ESUR-ESTRO-SIOG-Guidelines-on-Prostate-Cancer-2019-1.pdf. Google Scholar 7. : PI-RADS prostate imaging-reporting and data system: 2015, version 2. Eur Urol 2016; 69: 16. Google Scholar 8. : Practical barriers to obtaining pre-biopsy prostate MRI: assessment in over 1,500 consecutive men undergoing prostate biopsy in a single urologic practice. Urol Int 2016; 97: 247. Google Scholar 9. : The CAPRA-S score: a straightforward tool for improved prediction of outcomes after radical prostatectomy. Cancer 2011; 117: 5039. Google Scholar 10. : Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994; 271: 368. Google Scholar 11. : Prognostic value of percentage Gleason grade 4 at prostate biopsy in predicting prostatectomy pathology and recurrence. J Urol 2016; 196: 405. Link, Google Scholar 12. : Negative multiparametric magnetic resonance imaging for prostate cancer: what's next?Eur Urol 2018; 74: 48. Google Scholar 13. : Outcomes of Gleason score 3+4=7 prostate cancer with minimal amounts (<6%) vs ≥6% of Gleason pattern 4 tissue in needle biopsy specimens. Ann Diagn Pathol 2016; 20: 48. Google Scholar 14. : Gleason score 3+4=7 prostate cancer with minimal quantity of Gleason pattern 4 on needle biopsy is associated with low-risk tumor in radical prostatectomy specimen. Am J Surg Pathol 2014; 38: 1096. Google Scholar 15. : Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2019; 20: 100. Google Scholar 16. : MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med 2020; 382: 917. Google Scholar 17. : The institutional learning curve of magnetic resonance imaging-ultrasound fusion targeted prostate biopsy: temporal improvements in cancer detection in 4 years. J Urol 2018; 200: 1022. Link, Google Scholar 18. : The role of ipsilateral and contralateral transrectal ultrasound-guided systematic prostate biopsy in men with unilateral magnetic resonance imaging lesion undergoing magnetic resonance imaging-ultrasound fusion-targeted prostate biopsy. Urology 2017; 102: 178. Google Scholar 19. : Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol 2013; 189: 2039. Link, Google Scholar 20. : Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer 2017; 123: 592. Google Scholar 21. : Radical prostatectomy or observation for clinically localized prostate cancer: extended follow-up of the prostate cancer intervention versus observation trial (PIVOT). Eur Urol 2020; 77: 713. Google Scholar 22. : Predictive value of negative 3T multiparametric magnetic resonance imaging of the prostate on 12-core biopsy results. BJU Int 2016; 118: 515. Google Scholar 23. : What is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? A systematic review and meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. Eur Urol 2017; 72: 250. Google Scholar 24. : Negative multiparametric magnetic resonance imaging of the prostate predicts absence of clinically significant prostate cancer on 12-core template prostate biopsy. Urology 2017; 105: 118. Google Scholar 25. : Determination of the role of negative magnetic resonance imaging of the prostate in clinical practice: is biopsy still necessary?Urology 2017; 102: 190. Google Scholar 26. : Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389: 815. Google Scholar 27. : The accuracy of prostate magnetic resonance imaging interpretation: impact of the individual radiologist and clinical factors. Urology 2019; 127: 68. Google Scholar 28. : Accuracy and variability of prostate multiparametric magnetic resonance imaging interpretation using the prostate imaging reporting and data system: a blinded comparison of radiologists. Eur Urol Focus 2020; 6: 267. Google Scholar Samir S. Taneja is funded by the Joseph and Diane Steinberg Charitable Trust. Veeru Kasivisvanathan is an Academic Clinical Lecturer funded by the United Kingdom National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the UK National Institute for Health Research or the Department of Health. Caroline M Moore receives research funding from the Medical Research Council, Cancer Research UK, Movember, Prostate Cancer UK, the Pierre Brahm family. Xiaosong Meng was supported in part by the Urology Care Foundation Research Scholar Award Program and Society for Urologic Oncology Fund for Specialized Program of Research Excellence. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Urological Association or the Urology Care Foundation. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyDec 29, 2020, 12:00:00 AMEditorial Comment Volume 205Issue 3March 2021Page: 740-747 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsmagnetic resonance imagingprostatic neoplasmsbiopsyAcknowledgmentsPRECISION Study Collaborators: Veeru Kasivisvanathan, Antti S. Rannikko, Marcelo Borghi, Valeria Panebianco, Lance A. Mynderse, Markku H. Vaarala, Alberto Briganti, Lars Budäus, Giles Hellawell, Richard G. Hindley, Monique J. Roobol, Scott Eggener, Maneesh Ghei, Arnauld Villers, Franck Bladou, Geert M. Villeirs, Jaspal Virdi, Silvan Boxler, Grégoire Robert, Paras B. Singh, Wulphert Venderink, Boris A Hadaschik, Alain Ruffion, Jim C. Hu, Daniel Margolis, Sébastien Crouzet, Laurence Klotz, Samir S. Taneja, Peter Pinto, Inderbir Gill, Clare Allen, Francesco Giganti, Alex Freeman, Stephen Morris, Shonit Punwani, Norman R. Williams, Chris Brew-Graves, Jonathan Deeks, Yemisi Takwoingi, Mark Emberton, Caroline M. Moore.MetricsAuthor Information Zachary Feuer Department of Urology, NYU Langone Health, New York, New York More articles by this author Xiaosong Meng Department of Urology, NYU Langone Health, New York, New York More articles by this author Andrew B. Rosenkrantz Department of Radiology, NYU Langone Health, New York, New York More articles by this author Veeru Kasivisvanathan Division of Surgery and Interventional Science, University College of London, London, United Kingdom Financial and/or other relationship with the European Association of Urology. More articles by this author Caroline M. Moore Division of Surgery and Interventional Science, University College of London, London, United Kingdom Financial and/or other relationship with SonaCare, Janssen, Astellas and SpectraCure. More articles by this author Richard Huang Department of Urology, NYU Langone Health, New York, New York More articles by this author Fang-Ming Deng Department of Pathology, NYU Langone Health, New York, New York More articles by this author Herbert Lepor Department of Urology, NYU Langone Health, New York, New York More articles by this author James S. Wysock Department of Urology, NYU Langone Health, New York, New York More articles by this author William C. Huang Department of Urology, NYU Langone Health, New York, New York More articles by this author Samir S. Taneja Department of Urology, NYU Langone Health, New York, New York Department of Radiology, NYU Langone Health, New York, New York ‡Correspondence: Department of Urology, NYU Langone Health, 222 E. 41st Street, 12th Floor, New York, New York 10017 telephone: 201-790-4442; FAX: 646-825-6399). Financial and/or other relationship with Trod Medical, Francis Medical, Insightec, Janssen, MDX Health and Elsevier. More articles by this author Expand All Samir S. Taneja is funded by the Joseph and Diane Steinberg Charitable Trust. Veeru Kasivisvanathan is an Academic Clinical Lecturer funded by the United Kingdom National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the UK National Institute for Health Research or the Department of Health. Caroline M Moore receives research funding from the Medical Research Council, Cancer Research UK, Movember, Prostate Cancer UK, the Pierre Brahm family. Xiaosong Meng was supported in part by the Urology Care Foundation Research Scholar Award Program and Society for Urologic Oncology Fund for Specialized Program of Research Excellence. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Urological Association or the Urology Care Foundation. Advertisement Loading ...