Prostate cancer therapeutic strategies decided based on in-bore MRI-targeted prostate biopsies alone, or in combination with TRUS-guided biopsies.

PURPOSE: The purpose was to evaluate the concordance of prostate cancer therapeutic decisions based on in-bore MRI-targeted biopsies (MRI-TB) alone, with decisions based on combined in-bore MRI-TB and systematic US-guided biopsies.

METHODS

We included male biopsy-naïve patients, aged between 50 and ≤ 75 years, with PSA greater than 4 and/or a pathological digital rectal examination in this single-centre, exploratory, prospective, interventional study. All patients received T2-weighted MRI between November 2022 and May 2024, presenting a single lesion with a positive Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 3. In-bore MRI-TB were carried out with the assistance of a Remote-Controlled Manipulator. A second operator (radiologist), blind to in-bore MRI-TB results, carried out systematic 12-core TRUS-guided biopsies.We evaluated concordance of therapeutic decisions decided in a multidisciplinary team meeting (MDT1) based on in-bore MRI-TB only, with decisions based on the combined biopsies (MDT2, blind to MDT1 decision). ISUP score and cancer detection concordance, and tolerance and acceptability of the procedures were evaluated.

RESULTS

Fifty patients were included, with average age 63.4 years (SD 6.9). Therapeutic strategies were aligned for 43 patients, with a weighted Cohen's Kappa of 0.81 [95%CI 0.67;0.95], within the very good range. ISUP score concordance was very good (0.82 [0.68;0.97]) and cancer detection concordance was strong (0.63 [0.38;0.89]). Pain was higher after TRUS-guided biopsies. Fourteen (28%) patients preferred in-bore MRI-TB and 7 (14%) preferred TRUS-guided and 29 (58.0%) had no preference. No infections were recorded.

CONCLUSION

MRI-targeted biopsies reduce pain for patients. However, while there was excellent concordance between the two methods for therapeutic decisions and ISUP scores, the lower concordance for cancer detection means that systematic biopsies cannot yet be omitted for prostate cancer diagnosis.