Does systematic biopsy add value to prostate cancer detection rate?

In patients with suspected prostate cancer and positive (mp)MRI, targeted plus systematic biopsy did not perform better than targeted biopsy for its detection.

A substantial proportion of clinically significant prostate cancers was only detected through systematic biopsy1

mpMRI followed by targeted biopsy and systematic biopsy is the standard protocol to identify disease in individuals with suspected prostate cancer. “Whether systematic biopsy adds real value to the detection of prostate cancer is a topic of debate,” explained Dr Enrico Checcucci (University of Turin, Italy). To address this issue, Dr Checcucci and co-investigators developed a clinical trial in which participants with suspected prostate cancer and positive mpMRI were randomised to targeted biopsy plus systematic biopsy (n=190) or to targeted biopsy alone (n=201). The detection rates of prostate cancer and clinically significant prostate cancer were the endpoints of this trial.

The double biopsy protocol did not result in a significantly higher detection rate of prostate cancer than targeted biopsy alone (71.1% vs 64.7%; P=0.17). The corresponding detection rates of clinically significant prostate cancer displayed a similar pattern (63.2% vs 60.7%; P=0.61). However, Dr Checcucci pointed out that a non-negligible rate of clinically significant prostate cancers (7.9%) was detected with a positive systematic biopsy and a negative targeted biopsy. A multivariate analysis demonstrated that systematic biopsy was an independent predictive variable of prostate cancer in lesions with diameters below 10 mm (OR 3.84; P=0.04).

1. Checcucci E, et al. Target vs. Target plus Standard biopsy in naïve patients: Results of a prospective randomized controlled trial. Abstract 0455, EAU 2022, 01–04 July.