Improving Biopsy Strategies in Active Surveillance of Prostate Cancer

By Patrick Daly - Last Updated: November 30, 2022

Researchers investigated if adding systematic biopsy to multiparameter magnetic resonance imaging (MRI) targeting could improve periodic biopsies for active surveillance (AS) in patients with prostate cancer. The study’s first author, Mary O. Fakunle, presented the findings at the 23rd Annual Meeting of the Society of Urologic Oncology.

The study showed that lesions targeted by MRI were upgraded more often in patients who had repeat targeted biopsies; however, given that slightly more than one-third of lesion upgrades took place away from the MRI target, Fakunle and colleagues suggested that patients on AS could still benefit from additional systematic biopsies.

Systematic Biopsy Could Benefit Prostate Cancer Active Surveillance

The study included 619 men with early-stage prostate cancer who underwent 2 or more biopsy procedures that included both systematic and MRI-targeted sampling. The researchers compared timing and frequency of upgrades as well as Grade Group (GG) and target location between the biopsy samples.

Among the participants, 80% were GG 1 and 20% were GG 2 at the time of cancer diagnosis. A total of 250 (40%) had their initial MRI-targeted biopsy during confirmatory biopsies, while 274 (44%) had MRI targeting in follow-up surveillance biopsies. The highest-grade sample was obtained in the MRI-targeted biopsy in 70% to 90% of cases, and the median duration to stage upgrade was 26 months after MRI fusion biopsy.

Additionally, in patients who had 2 consecutive MRI biopsies, the MRI-targeted lesion was upgraded in 64% of patients. In the remaining patients, upgrading outside of the MRI target was observed primarily in systematic-targeted lesions (93%), followed by a small number of transrectal ultrasound-targeted lesions (7%).

Fakunle and the researchers concluded that systematic biopsies could improve outcomes of active surveillance in patients with prostate cancer.