Samir S. Taneja, MD, presented “Management of Men With PI-RADS 4-5 Lesions and Negative Biopsy” during the 25th Annual Southwest Prostate Cancer Symposium conference on December 9, 2021, in Scottsdale, Arizona.
How to cite: Taneja, Samir S. “Management of Men With PI-RADS 4-5 Lesions and Negative Biopsy.” December 9, 2021. Accessed Apr 2024. https://grandroundsinurology.com/management-of-men-with-pi-rads-4-5-lesions-and-negative-biopsy/
Management of Men With PI-RADS 4-5 Lesions and Negative Biopsy
Samir S. Taneja, MD, Professor of Urologic Oncology at NYU Grossman School of Medicine, discusses how to approach a negative MRI-targeted prostate biopsy in men with PI-RADS 4 or 5 lesions, explaining both why an MRI-targeted biopsy for a high suspicion MRI might be benign and what steps to take to determine the biopsy’s accuracy. Citing the PROMIS study, he notes that MRI is not entirely accurate and has neither a perfect positive predictive value (PPV) nor a perfect negative predictive value (NPV), though PPV is better at Gleason Grade greater than or equal to 3+4. Dr. Taneja then lists factors influencing PPV of MRI/template biopsy, including the given definition of clinically significant prostate cancer (csPCa), indication for biopsy, the prevalence of disease in the sampled cohort, and biopsy technique/operator skill. He goes into depth on how the MRI-targeted biopsy technique might influence the likelihood of a false negative, noting how the PROFUS study showed that csPCa was more often found with fusion biopsy compared to visual targeting. Dr. Taneja also considers the significance of the number of cores taken, observing that while most men are diagnosed with csPCa in the first core, there is a subset that requires core 3 and 4. He synthesizes the data into a set of suggestions for a clinical approach to a negative MRI-targeted biopsy in the setting of PI-RADS 4-5 abnormality, stating that clinicians should assess how confident they should be in the biopsy, assess the accuracy of imaging, repeat imaging in 6-12 months to rule out a false positive and, if the abnormality persists, they should perform a repeat biopsy.
About the 25th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, and Richard G. Stock, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
