How Would MRI-Targeted Prostate Biopsy Alter Radiation Therapy Approaches in Treating Prostate Cancer?

Abstract Objectives To determine if MRI/ultrasound fusion-targeted prostate biopsy (TB) would lead to increased recommendations of aggressive radiotherapy treatments for higher risk prostate cancer compared to systematic biopsy (SB) results. Methods Clinicopathologic data of 533 men who underwent both TB and SB from 2014-2017 was analyzed. TB was performed in addition to SB in patients with detection of MRI suspicious lesions. Three patient cohorts were established: (1) biopsy naive (80/533,15.0%), (2) active surveillance (185/533,34.7%), and (3) prior negative biopsy (268/533,50.3%). Cancer risk categorical criteria were established with recommended radiotherapy treatment for each. Variation of risk classification due to biopsy method for all patients and within each cohort were analyzed using either a chi-squared statistic or Fisher's Exact test. McNemar's pairwise analyses were performed for all risk categories between TB and SB to assess the effects of TB on high-risk cancer identification and subsequent radiotherapy recommendations. Results Number of patients within cancer risk categories (1.“No Cancer or Low-Risk”; 2.“More Favorable Intermediate-Risk”; 3.“Less Favorable Intermediate-Risk”; 4.“High-Risk”) varied significantly based on TB and SB pathology among all patients combined(p Conclusions Among men with prostate cancer, TB commonly led to reclassification to a higher risk group, which is accompanied by more aggressive radiotherapy treatment recommendations when compared with SB findings alone.