Early second round targeted biopsy of PI-RADS score 3 or 4 in 256 men with persistent suspicion of prostate cancer

Abstract

Background/Aim: The aim of the study was to determine the rate of clinically significant prostate cancer (csPCa) cases in men submitted to early second round mpMRI/TRUS (multiparametric magnetic resonance imaging/transrectal ultrasound) fusion biopsy (TPBx). Materials and Methods: From January 2016 to December 2018, 256 men with a PI-RADS (Prostate Imaging-Reporting and Data System) score 3 (80 cases) or 4 (176 cases) and negative repeat transperineal saturation biopsy plus TPBx, underwent a new TPBx (four cores) for the persistent clinical suspicion of cancer. The accuracy of mpMRI ADC (apparent diffusion coefficient) values in the diagnosis of csPCa were evaluated. Results: Overall detection rate of csPCa was equal to 10.1% (26/256 cases): 2.5% (2/80) versus 13.6% (24/176) had a PI-RADS score equal to 3 versus 4, respectively. The presence of csPCa was significantly correlated with an ADC value of 0.747×10–3 mm2/sec. Conclusion: A negative TBPx missed a csPCa in 13.6% of PI-RADS score 4 that was diagnosed by an early second round TBPx; the evaluation of ADC maps could select mpMRI lesions deserving a repeat TPBx.