Common cores.

Top Line: In practice, it’s common to perform multi-parametric MRI followed by a targeted/12-core biopsy combo for prostate cancer.

The Study: Is all that necessary? The PRECISION trial showed us that targeted biopsy in men with PI-RADS 3+ lesions led to a lower biopsy rate and a higher proportion diagnosed with clinically significant (grade group 3+) prostate cancer. The problem is that we (practitioners) are still very worried about mis-diagnosis as opposed to under-diagnosis. The Trio Study was conducted at the NCI and helped lead to development of the UroNav fusion biopsy system. In that study, >2000 men with suspicion of prostate cancer on MRI underwent both a targeted and systematic 12-core biopsy in order to determine the cancer detection rate of each method. Overall, nearly two-thirds of the cohort was diagnosed with prostate cancer with almost identical rates of diagnosis made with each biopsy method alone (~52%). Combination biopsy, though, diagnosed 10% more prostate cancer (62%) than either fusion or 12-core alone. As we’ve seen before, the proportion of clinically significant diagnoses was higher with targeted biopsies (39%) than with 12-core (26%). The combination also led to a higher grade group diagnosis in 22% of men. When compared to the gold standard path eval of prostatectomy (done in 404 participants), 3.5% of combination results, 8.7% of targeted results, and 16.8% of 12-core results were upgraded to clinically significant disease. Their conclusion is that, until we have refined the MR approach, a sizable proportion of men are incorrectly graded by either targeted or 12-core biopsy alone. 

TBL: Performing both MRI-targeted and systematic 12-core prostate biopsies in men with MRI-visible lesions increases the detection rate and diagnostic accuracy of prostate cancer. | Ahdoot, N Engl J Med 2020