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MP49-04 IS MULTIPARAMETRIC MRI ALWAYS NEEDED IN BIOPSY-NAÏVE PATIENTS WITH ABNORMAL DIGITAL RECTAL EXAMINATION? A SINGLE-INSTITUTIONAL EXPERIENCE COMBINING CLINICAL AND MICRO-ULTRASONOGRAPHY BASED FACTORS TO OPTIMIZE PROSTATE CANCER DETECTION

2024; Lippincott Williams & Wilkins; Volume: 211; Issue: 5S Linguagem: Inglês

10.1097/01.ju.0001008696.31772.28.04

1527-3792

Pier Paolo Avolio, Davide Maffei, Vittorio Fasuolo, Marco Paciotti, Cesare Saitta, Fabio De Carne, Giuseppe Chiarelli, Alberto Saita, Massimo Lazzeri, Paolo Casale, Nicolò Maria Buffi, Giovanni Lughezzani,

Advanced X-ray and CT Imaging

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP49)1 May 2024MP49-04 IS MULTIPARAMETRIC MRI ALWAYS NEEDED IN BIOPSY-NAÏVE PATIENTS WITH ABNORMAL DIGITAL RECTAL EXAMINATION? A SINGLE-INSTITUTIONAL EXPERIENCE COMBINING CLINICAL AND MICRO-ULTRASONOGRAPHY BASED FACTORS TO OPTIMIZE PROSTATE CANCER DETECTION Pier Paolo Avolio, Davide Maffei, Vittorio Fasuolo, Marco Paciotti, Cesare Saitta, Fabio De Carne, Giuseppe Chiarelli, Alberto Saita, Massimo Lazzeri, Paolo Casale, Nicolò Maria Buffi, and Giovanni Lughezzani Pier Paolo AvolioPier Paolo Avolio , Davide MaffeiDavide Maffei , Vittorio FasuoloVittorio Fasuolo , Marco PaciottiMarco Paciotti , Cesare SaittaCesare Saitta , Fabio De CarneFabio De Carne , Giuseppe ChiarelliGiuseppe Chiarelli , Alberto SaitaAlberto Saita , Massimo LazzeriMassimo Lazzeri , Paolo CasalePaolo Casale , Nicolò Maria BuffiNicolò Maria Buffi , and Giovanni LughezzaniGiovanni Lughezzani View All Author Informationhttps://doi.org/10.1097/01.JU.0001008696.31772.28.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the diagnostic performance of microultrasound-targeted biopsy (microUSTBx) and systematic biopsy (SBx) in detecting clinically significant prostate cancer (csPCa) among men with abnormal digital rectal examination (DRE) and suspicious lesions at multiparametric magnetic resonance imaging (mpMRI), and to compare the diagnostic performance of this approach with a mpMRI guided-targeted biopsy (MTBx) plus SBx-based strategy. METHODS: Biopsy-naïve men with suspicious lesions at mpMRI and abnormal DRE were prospectively evaluated between October 2017 and January 2023. Primary outcome was to compare csPCa detection rate by microUSTBx plus SBx and MTBx plus SBx. Secondary outcomes were to assess the proportion of patients with abnormal DRE who may avoid MTBx and the proportion of missed csPCa; to assess the predictors of csPCa in patients with abnormal DRE, to assess and compare the clinical benefit of both microUS plus prostate-specific antigen density (PSAd) and mpMRI plus PSAd in this sub-cohort of patients. RESULTS: Overall, 182 biopsy naïve men were included. MicroUSTBx plus SBx achieved comparable detection rate to MTBx plus SBx in diagnosis of ciPCa and csPCa (ciPCa: 9.3% [17/182] vs 10% [19/182] p=0.5; csPCa: 63% [114/ 182] vs 62% [113/ 182]; p=0.6). MicroUSTBx outperformed MTBx (ciPCa: 5.5% [10/182] vs 6.0% [11/182], p=0.3; csPCa: 57% [103/182] vs 54% [99/182]; p=0.07). Using microUSTBx plus SBx would have avoided 68/182 (37%) unnecessary MTBx, while missing only 2/116 (1.7%) csPCa. At multivariable logistic regression model Prostate Risk Identification Using Micro-Ultrasound ≥ 3, Prostate Imaging Report and Data System≥4 and PSAd≥0.15 ng/ml2 emerged as independent predictors of csPCa (odds ratio: 4.28 [95% CI 1.39-13.2]; p=0.01; 3.05 [95% CI 1.81-5.14]; p<0.001; and 2.72 [95% CI 1.32-5.59]; p=0.006; respectively). The decision curve analysis of suspicious microUS plus PSAd≥0.15 ng/ml2 showed higher net benefit in the ability to identify true positives and reduce the number of unnecessary prostate biopsy in this subcategory of patients. CONCLUSIONS: The combination of microUSTBx and SBx showed equal diagnostic performance to an mpMRI-based approach in biopsy-naïve patients with an abnormal DRE. The combination of this approach with PSAd maximize the diagnostic accuracy while lowering the need for unnecessary biopsies. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e783 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Pier Paolo Avolio More articles by this author Davide Maffei More articles by this author Vittorio Fasuolo More articles by this author Marco Paciotti More articles by this author Cesare Saitta More articles by this author Fabio De Carne More articles by this author Giuseppe Chiarelli More articles by this author Alberto Saita More articles by this author Massimo Lazzeri More articles by this author Paolo Casale More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...