Followup of Men with PI-RADS™ 4 or 5 Abnormality on Prostate Magnetic Resonance Imaging and Nonmalignant Pathological Findings on Initial Targeted Prostate Biopsy

No AccessJournal of UrologyAdult Urology1 Mar 2021Followup of Men with PI-RADS™ 4 or 5 Abnormality on Prostate Magnetic Resonance Imaging and Nonmalignant Pathological Findings on Initial Targeted Prostate Biopsy Xiaosong Meng, Brian Chao, Fei Chen, Richard Huang, Samir S. Taneja, and Fang-Ming Deng Xiaosong MengXiaosong Meng Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas Urology Care Foundation research scholarship award for mentored research during fellowship. More articles by this author , Brian ChaoBrian Chao Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York More articles by this author , Fei ChenFei Chen Departments of Pathology, NYU Langone Health, New York, New York More articles by this author , Richard HuangRichard Huang Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York More articles by this author , Samir S. TanejaSamir S. Taneja Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York Departments of Radiology, NYU Langone Health, New York, New York Departments of Biomedical Engineering, NYU Langone Health, New York, New York More articles by this author , and Fang-Ming DengFang-Ming Deng †Correspondence: Department of Pathology, NYU Langone Health, 550 1st Ave., Suite TH461, New York, New York 10016 telephone: 212-263-5470; E-mail Address: [email protected] Departments of Pathology, NYU Langone Health, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001424AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A benign magnetic resonance imaging targeted prostate biopsy in the setting of a PI-RADS™ 4/5 abnormality presents a clinical dilemma for future management. We evaluated benign histological features on magnetic resonance imaging targeted prostate biopsy to determine if they predict the likelihood of missed cancer on subsequent biopsy. Materials and Methods: Between June 2012 and September 2016, 1,595 men were enrolled in a prospective study of magnetic resonance imaging targeted and systematic biopsy outcomes. We re-reviewed pathology from benign biopsies of PI-RADS 4/5 abnormalities and divided them into 5 groups for comparison to outcomes of clinical followup: inflammation (38%), stroma/glandular hyperplasia (9%), normal prostate tissue (28%), atypical small acinar proliferation/high grade prostatic intraepithelial neoplasia (9%) and cancer in adjacent systematic cores (16%). Results: Of 497 men 88 (18%) with PI-RADS 4/5 abnormality prior to initial biopsy had no cancer on magnetic resonance imaging targeted prostate biopsy. On followup, 45 men underwent repeat magnetic resonance imaging: 12 (27%) had persistent PI-RADS 4/5 abnormalities, 17 (38%) had PI-RADS 2/3, 16 (35%) had PI-RADS 1. On repeat magnetic resonance imaging targeted prostate biopsy, cancer was found in 62.5% of men with PI-RADS 4/5 and 23% of men with PI-RADS 2/3. Histological groups on initial biopsy were not predictive of the likelihood of PI-RADS downgrade on repeat magnetic resonance imaging or cancer detection on repeat biopsy. Conclusions: Among men with no cancer on magnetic resonance imaging targeted prostate biopsy performed for PI-RADS abnormality, downgrade of PI-RADS score is noted in 73% on repeat magnetic resonance imaging. Persistence of PI-RADS 4/5 predicts a higher risk of missed cancer, warranting prompt re-biopsy. While histological findings such as inflammation may underlie some PI-RADS 4/5 abnormalities, initial histology is a poor predictor of cancer likelihood on repeat biopsy. 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This work was also supported in part by the Joseph and Diane Steinberg Charitable Trust © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 205, NO. 3, (647-648), Online publication date: 1-Mar-2021.Stavrinides V, Giganti F, Allen C, Kirkham A, Punwani S, Freeman A, Norris J, Pashayan N, Moore C and Emberton M (2020) Followup of Men with PI-RADSTM 4 or 5 Abnormality on Prostate Magnetic Resonance Imaging and Nonmalignant Pathological Findings on Initial Targeted Prostate Biopsy. Letter.Journal of Urology, VOL. 205, NO. 5, (1526-1528), Online publication date: 1-May-2021.Montorsi F, Stabile A, Gandaglia G, Dehò F, Salonia A and Briganti A (2021) Followup of Men with PI-RADS™ 4 or 5 Abnormality on Prostate Magnetic Resonance Imaging and Nonmalignant Pathological Findings on Initial Targeted Prostate Biopsy. Letter.Journal of Urology, VOL. 206, NO. 5, (1335-1335), Online publication date: 1-Nov-2021. Volume 205Issue 3March 2021Page: 748-754 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsmagnetic resonance imagingbiopsyMetricsAuthor Information Xiaosong Meng Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas Urology Care Foundation research scholarship award for mentored research during fellowship. More articles by this author Brian Chao Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York More articles by this author Fei Chen Departments of Pathology, NYU Langone Health, New York, New York More articles by this author Richard Huang Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York More articles by this author Samir S. Taneja Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York Departments of Radiology, NYU Langone Health, New York, New York Departments of Biomedical Engineering, NYU Langone Health, New York, New York More articles by this author Fang-Ming Deng Departments of Pathology, NYU Langone Health, New York, New York †Correspondence: Department of Pathology, NYU Langone Health, 550 1st Ave., Suite TH461, New York, New York 10016 telephone: 212-263-5470; E-mail Address: [email protected] More articles by this author Expand All Supported in part by the Urology Care Foundation Research Scholar Award Program and Society for Urologic Oncology Fund for Specialized Program of Research Excellence (for XM). 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. This work was also supported in part by the Joseph and Diane Steinberg Charitable Trust Advertisement Loading ...