Introduction:

Prostatic mpMRI fusion biopsy is increasingly utilized for the diagnosis and risk stratification of men with prostate cancer (CaP). The PRECISION trial reported cancer detection rates (CDR) in relation to the PIRAD scoring system and established the reference standard for reporting CDR based on PIRADS classification. Development of a mpMRI fusion biopsy program requires multi-disciplinary collaboration and review of diagnostic yield. We review outcomes of an initial experience of over 1000 patients treated at 4 different centers in the U.S. (3 academic, 1 community based)

Methods:

Records of men who underwent transrectal mpMRI guided fusion biopsy from 2017-2020 for suspected CaP were reviewed. Clinical, pathological and index tumor lesion radiologic data were collected. Aggregate outcomes as well as site specific data was annotated for CDR across PIRADS 3, 4 and 5 lesions. Temporal CDR was evaluated by dividing all patients into 2 sub-cohorts and analyzing the detection of clinically significant cancer (Grade Group≥2) in PI-RADS score (≥3) lesion

Results:

1029 consecutive patients with a median PSA of 7.8 ng/dL (IQR, 4.9 –10.8) were included. Median age was 66 years (IQR, 63-69) and prostate volume was 54 cc (IQR, 34-74). The majority of patients previously had a prostate biopsy (51%, 524/1029) and 89% (914/1029) were Caucasian. Figure 1 demonstrates CDR across PIRADS 3, 4 and 5 lesions across all centers in aggregate. Overall, clinically significant prostate cancer was identified in 16% of PIRADS 3, 37% of PIRADS 4, and 59% of PIRADS 5 lesions. Temporal improvement was modest, whereby clinically significant CDR of PIRADS 4 and PIRADS 5 remained relatively stable from 39.8% (80/201) to 33.2% (62/187) (p=0.17) and from 56.3% (94/167) to 61.8% (94/152) (p=0.31), respectively.

Conclusion:

Clinically significant prostate cancer was observed in 37% of PIRADS 4 and 59% of PIRADS 5 lesions without significant change over time. Such results are somewhat humbling and may be attributable to a heterogeneous cohort across institutions with variable techniques, volumes, and practice settings. Nonetheless, these observations emphasize that work is requisite to further address barriers to temporal improvement and improve diagnostic proficiency.

Funding: None