California: Repeated biopsy may be avoided in men with negative magnetic resonance imaging (MRI) following an initial negative MRI guided biopsy as it is unlikely to harbor significant prostate cancer, reveals a recent study. The study, published in the Journal of Urology, however, found that when lesion are seen on followup MRI, repeat MRI guided biopsy is warranted.
MRI guided biopsy that shows no cancer may provide reassurance beyond that offered by ultrasound guided biopsy. However, followup of men after a negative MRI guided biopsy has been mostly done by prostate specific antigen testing and reports of followup tissue confirmation are few. Leonard S. Marks, University of California at Los Angeles, Los Angeles, California, and colleagues investigated the incidence of clinically significant prostate cancer in such men who, because of persistent cancer suspicion, subsequently underwent a repeat magnetic resonance imaging guided biopsy.
The study included men with a negative initial MRI guided biopsy who underwent at least 1 further MRI guided biopsy due to continued clinical suspicion of clinically significant prostate cancer (September 2009 to July 2019). Biopsies were MRI-ultrasound fusion with targeted and systematic cores. Regions of interest from initial MRI and any new regions of interest at followup magnetic resonance imaging guided biopsy were targeted.
The primary end point was detection of clinically significant prostate cancer (Gleason Grade Group 2 or greater).
Of 2,716 men 733 had a negative initial magnetic resonance imaging guided biopsy. Study subjects were 73/733 who underwent followup magnetic resonance imaging guided biopsy.
Key findings of the study include:
Median (IQR) age and prostate specific antigen density were 64 years (59–67) and 0.12 ng/ml/cc (0.08–0.17), respectively.
Baseline PI-RADS® scores were 3 or greater in 74%.
At followup magnetic resonance imaging guided biopsy (median 2.4 years, IQR 1.3–3.6), 17/73 (23%) were diagnosed with clinically significant prostate cancer.
When followup magnetic resonance imaging revealed a lesion (PI-RADS 3 or greater), clinically significant prostate cancer was found in 17/53 (32%).
When followup magnetic resonance imaging was negative (PI-RADS less than 3), cancer was not found (0/20).
Overall 54% of men with PI-RADS 5 at followup magnetic resonance imaging guided biopsy were found to have clinically significant prostate cancer.
"Men with negative magnetic resonance imaging following an initial negative magnetic resonance imaging guided biopsy are unlikely to harbor clinically significant prostate cancer and may avoid repeat biopsy. However, when lesions are seen on followup magnetic resonance imaging, repeat magnetic resonance imaging guided biopsy is warranted," concluded the authors.
The study, "Risk of Prostate Cancer after a Negative Magnetic Resonance Imaging Guided Biopsy," is published in the Journal of Urology.
DOI: https://www.auajournals.org/doi/10.1097/JU.0000000000001232