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Optimizing multiparametric magnetic resonance imaging-targeted biopsy and detection of clinically significant prostate cancer: the role of perilesional sampling

Prostate Cancer and Prostatic Diseases volume 26, pages 575–580 (2023)Cite this article

Subjects

Abstract

Background

The added-value of systematic biopsy (SB) in patients undergoing magnetic resonance imaging (MRI)-targeted biopsy (TB) remains unclear and the spatial distribution of positive cores relative to the MRI lesion has been poorly studied. The aim of this study was to determine the utility of perilesional biopsy in detecting clinically significant prostate cancer (csPCa).

Methods

We enrolled 505 consecutive patients that underwent SB and TB for suspicious MRI lesions (PI-RADS score 3-5) at Jules Bordet Institute between June 2016 and January 2022. Patient-specific tridimensional prostate maps were reviewed to determine the distance between systematic cores containing csPCa and the MRI index lesion. Primary outcomes were the cancer detection rate (CDR) per patient and the cumulative cancer distribution rate of positive cores for each 5 mm interval from the MRI index lesion. The secondary outcome was the identification of risk groups for the presence of csPCa beyond a 10 mm margin using the chi-square automated interaction detector (CHAID) machine learning algorithm.

Results

Overall, the CDR for csPCa of TB, SB, and combined method were 32%, 25%, and 37%, respectively. While combined method detected more csPCa compared to TB (37% vs. 32%, p < 0.001), no difference was found when TB was associated with perilesional sampling within 10 mm (37% vs. 35%, p = 0.2). The cumulative cancer distribution rate for csPCa reached 86% for the 10 mm margin. The CHAID algorithm identified three risk groups: (1) PI-RADS3 (“low-risk”), (2) PI-RADS4 or PI-RADS5 and PSA density <0.15 ng/ml (“intermediate-risk”), and (3) PI-RADS 5 and PSA density ≥0.15 ng/ml (“high-risk”). The risk of missing csPCa was 2%, 8%, and 29% for low-, intermediate- and high-risk groups, respectively. Avoiding biopsies beyond a 10 mm margin prevented the detection of 19% of non-csPCa.

Conclusions

Perilesional biopsy template using a 10 mm margin seems a reasonable alternative to the combined method with a comparable detection of csPCa. Our risk stratification may further enhance the selection of patients.

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Fig. 1: Patient-specific 3D prostate map after MRI-targeted and systematic biopsies.
Fig. 2: Cumulative distribution of biopsy cores with clinically significant prostate cancer around MRI lesion.
Fig. 3: Risk groups for the detection of csPCa in biopsies taken beyond 10 mm from the MRI lesion.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. These authors contributed equally: Jean-Paul Noujeim, Yassir Belahsen.

Authors and Affiliations

  1. Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    Jean-Paul Noujeim, Yassir Belahsen, Robin Martin, Thierry Roumeguère, Alexandre Peltier & Romain Diamand

  2. Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    Yolene Lefebvre, Marc Lemort & Maxime Deforche

  3. Department of Pathology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    Nicolas Sirtaine

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Contributions

JPN, YB: Project development, Data collection, Data analysis, Manuscript writing. RD: Project development, Supervision, Manuscript editing. TR, AP: Supervision. YL, ML, MD, NS, RB: Data collection.

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Correspondence to Romain Diamand.

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Noujeim, JP., Belahsen, Y., Lefebvre, Y. et al. Optimizing multiparametric magnetic resonance imaging-targeted biopsy and detection of clinically significant prostate cancer: the role of perilesional sampling. Prostate Cancer Prostatic Dis 26, 575–580 (2023). https://doi.org/10.1038/s41391-022-00620-8

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