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Kornienko K, Reuter M, Maxeiner A, Günzel K, Kittner B, Reimann M, Hofbauer SL, Wiemer LE, Heckmann R, Asbach P, Wendler JJ, Schostak M, Schlomm T, Friedersdorff F, Cash H. Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy. Sci Rep 2022; 12:13603. [PMID: 35948575 PMCID: PMC9365776 DOI: 10.1038/s41598-022-17260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance imaging/Ultrasound (MRI/US) fusion targeted biopsy (TB) in combination with a systematic biopsy (SB) improves cancer detection but limited data is available how to manage patients with a Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 4 lesion and a negative biopsy. We evaluate the real-world management and the rate of clinically significant Prostate Cancer (csPCa) during follow-up. 1546 patients with a multi-parametric MRI (mpMRI) and a PI-RADS ≥ 3 who underwent SB and TB between January 2012 and May 2017 were retrospectively analyzed. 222 men with a PI-RADS ≥ 4 and a negative biopsy were included until 2019. For 177/222 (80%) complete follow-up data was obtained. 66/84 (78%) had an initial PI-RADS 4 and 18 (22%) a PI-RADS 5 lesion. 48% (84/177) received a repeat mpMRI; in the follow-up mpMRI, 39/84 (46%) lesions were downgraded to PI-RADS 2 and 11 (13%) to PI-RADS 3; three cases were upgraded and 28 lesions remained consistent. 18% (32/177) men underwent repeated TB and csPCa was detected in 44% (14/32). Our study presents real world data on the management of men with a negative TB biopsy. Men with a positive mpMRI and lesions with high suspicion (PI-RADS4/5) and a negative targeted biopsy should be critically reviewed and considered for repeat biopsy or strict surveillance. The optimal clinical risk assessment remains to be further evaluated.
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Affiliation(s)
- Kira Kornienko
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Miriam Reuter
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Vivantes Am Urban, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Sebastian L Hofbauer
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Laura E Wiemer
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Robin Heckmann
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Patrick Asbach
- Clinic for Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Schostak
- Department of Urology, University Magdeburg, Magdeburg, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany.
- Department of Urology, University Magdeburg, Magdeburg, Germany.
- PROURO, Berlin, Germany.
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