EURURO Vol. 72 No. 2

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3.3. Targeted biopsy detection rate according to Prostate
Imaging–Reporting and Data System score
In arm A, mpMRI found one suspected lesion in 54 patients
(66.7%) and two suspected lesions in 27 patients (33.3%).
The DRs of PCa and csPCa by TB according to PI-RADS scores
are reported in .
3.4. Number of samples and pathologic characteristics
In arm A, 800 cores were obtained: 488 by the TB approach
and 312 by the SB approach. In arm B, 1260 cores were
sampled.
The median total numbers of biopsies per patient were
6 (IQR: 5–12) and 12 (IQR: 12–12) in arms A and B,
respectively (p < 0.001). The median numbers of positive
cores per patient were 4 (IQR: 2–6) and 3 (IQR: 2–4) in arms
A and B, respectively (p = 0.105).
In the subgroup analysis, the median numbers of positive
cores per patient were 4 (IQR: 3–6), 1 (IQR: 1–1), and 3 (2–4)
by TB in both arms, SB in arm A, and SB in arm B,
respectively (p = 0.001).
Pathologic characteristics are reported in .
4. Discussion
The advent of mpMRI has changed the approach to
prostate biopsy, allowing clinicians to direct biopsies
to suspected lesions rather than operating randomly.
In 2009, it was estimated that the cost of unnecessary
prostate biopsies was greater than that of mpMRI
.
Biopsy-naı¨ve men seem to be the ideal population for
mpMRI. This imaging method has great potential to reduce
overdiagnosis in men with high risk of indolent disease
detection with random biopsy.
Table 1 – Demographic characteristics of the study population
Arm A, mpMRI group Arm B, control group
Group size, n 107 105
Age, yr 64 (58–70) 66 (60–70)
PSA, ng/ml 5.9 (4.8–7.5) 6.7 (5.5–8.5)
Prostate volume, ml 46.2 (34.5–71.6) 45.7 (34.6–65.0)
TB SB, arm A SB, arm B
Group size, n 81 26 105
Age, yr 64 (59–70) 63 (58–69) 66 (60–70)
PSA, ng/ml 5.9 (4.8–7.3) 6.1 (5.3–7.5) 6.7 (5.5–8.5)
Prostate volume, ml 44.4 (34.2–67.3) 55.6 (39.5–72.6) 45.7 (34.6–65.0)
mpMRI = multiparametric magnetic resonance imaging; PSA = prostate-specific antigen; SB = standard biopsy; TB = targeted biopsy.
Data for continuous variables are reported as the median (interquartile range).
Table 2 – Comparison of cancer detection rates in terms of randomization arm and biopsy approach
Arm A, mpMRI group Arm B, control group p value
Group size, n 107 105
Overall detection of PCa, no. (%) 54 (50.5) 31 (29.5) 0.002
Overall detection of csPCa, no. (%) 47 (43.9) 19 (18.1) <0.001
Ratio of overall detection of csPCa/PCa, % 87.0 61.3 0.013
TB SB, arm A SB, arm B p value
Group size, n 81 26 105
Overall detection of PCa, no. (%) 49 (60.5) 5 (19.2) 31 (29.5) <0.001
Overall detection of csPCa, no. (%) 46 (56.8) 1 (3.8) 19 (18.1) <0.001
Ratio of overall detection of csPCa/PCa, % 93.9 20.0 61.3 <0.001
csPCa = clinically significant prostate cancer; mpMRI = multiparametric magnetic resonance imaging; PCa = prostate cancer; SB = standard biopsy;
TB = targeted biopsy.
Table 3 – Comparison of cancer detection rates by Prostate Imaging–Reporting and Data System score in patients from arm A with
multiparametric magnetic resonance imaging evidence of lesions suspicious for prostate cancer
PI-RADS score 3 PI-RADS score 4 PI-RADS score 5 p value
Group size, n 24 40 16
Overall detection of PCa, no. (%) 3 (12.5) 32 (80.0) 14 (87.5) <0.001
Overall detection of csPCa, no. (%) 3 (12.5) 30 (75) 13 (81.3) <0.001
Ratio of overall detection of csPCa/PCa, % 100.0 93.8 92.9 1.000
csPCa = clinically significant prostate cancer; PCa = prostate cancer; PI-RADS = Prostate Imaging–Reporting and Data System.
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