Clinical Scorecard: Importance of Perilesional Biopsies in MRI-Guided and Systematic Biopsy Techniques for Prostate Cancer Detection: Findings from a Prospective, Non-Randomized, Surgeon-Blinded Study

At a Glance

Key Highlights

• Multiparametric MRI prior to biopsy is the gold standard for primary PCa diagnosis per EAU guidelines.
• Combined SB and TB increase detection of clinically significant PCa while reducing clinically insignificant PCa detection.
• Perilesional biopsies target tissue within 5–10 mm around MRI-identified lesions to potentially replace systematic biopsies.

Guideline-Based Recommendations

Diagnosis

• Perform multiparametric MRI before prostate biopsy.
• If PI-RADS score ≥3, conduct combined systematic and MRI-ultrasound fusion targeted biopsies.

Management

• Use local anesthesia and prophylactic antibiotics (intravenous ceftriaxone pre-biopsy and oral cephalosporin post-biopsy).
• Perform 12-core systematic biopsy blinded to MRI findings, followed by 3-5 targeted biopsies and 6 perilesional biopsies around each lesion.

Monitoring & Follow-up

• Monitor PSA levels and prostate volume prior to biopsy.
• Assess biopsy cores for ISUP grade and percentage infiltration.

Risks

• Potential under-detection of csPCa if systematic biopsies are omitted.
• Risk of infectious complications mitigated by antibiotic prophylaxis and rectal disinfection.

Patient & Prescribing Data

Men with elevated PSA and suspicious MRI findings undergoing prostate biopsy

Addition of perilesional biopsies may improve detection of clinically significant prostate cancer without increasing detection of clinically insignificant cases, potentially reducing the need for extensive systematic biopsies.

Clinical Best Practices

• Perform MRI within six months prior to biopsy using 1.5 or 3 Tesla scanners with standard imaging sequences.
• Use surgeon-blinded systematic biopsy first to avoid operator bias.
• Apply MRI-ultrasound fusion technology for targeted and perilesional biopsies.
• Administer appropriate antibiotic prophylaxis and local anesthesia to improve tolerability and reduce infection risk.
• Include perilesional biopsies within 10 mm radius around PI-RADS lesions to capture csPCa potentially missed by MRI.

References

• European Association of Urology (EAU) Guidelines on Prostate Cancer
• Prostate Imaging Reporting and Data System (PI-RADS)