To assess the necessity of incorporating MRI prior to initial biopsy and to investigate clinical measures predicting the safety of a reduced biopsy approach using only systematic biopsy (SB) in biopsy-naïve patients.
Key Findings:
Clinically significant PCA (csPCA) was detected in 72.7% of cases, with 21.0% classified as high-risk PCA (Gleason ≥ 8).
Combined biopsy (CB) showed significantly higher CDR for PCA, csPCA, and high-risk PCA compared to targeted biopsy (TB) and systematic biopsy (SB).
SB had a higher overall CDR (91.3%) than TB (83.1%), but csPCA detection rates were similar between the two methods.
TB detected 8.6% less non-significant PCA than SB.
In patients with PSA > 20 ng/ml, CB outperformed SB significantly.
Interpretation:
While MRI-targeted biopsy offers advantages in cancer detection, it cannot replace systematic biopsy entirely due to variability in predictive values and technical limitations, as evidenced by the study's findings.
Limitations:
Technical limitations in MRI interpretation and variability among radiologists.
Negative predictive value of MRI is inconsistent, necessitating continued use of SB.
Access and cost barriers limit the widespread implementation of advanced biopsy techniques, impacting patient care.
Conclusion:
MRI should not be universally mandated for all biopsy-naïve patients; individual risk assessment remains crucial, and systematic biopsy is still necessary in many cases, particularly for those with high-risk indicators.
