Study Demonstrates Effectiveness of PRECISION Biopsy Strategy in Prostate Cancer Detection

A study aimed at demonstrating the generalizability of the PRECISION trial findings and applying its biopsy strategy to a contemporary cohort has shed light on the detection and characteristics of prostate cancers that might be missed using this approach. The research involved 629 men who underwent biopsies between February 2015 and September 2018, meeting the PRECISION inclusion criteria. The strategy involved biopsying men with PI-RADS™ 1-2 magnetic resonance imaging (MRI) only if there was a high clinical suspicion for cancer.

Key Findings:

• Avoidance of Biopsy: The application of the PRECISION biopsy strategy led to the avoidance of biopsy in 28% of cases.
• Detection Rates: The study found a similar MRI-targeted prostate biopsy detection rate to that of the PRECISION trial, with a 60% reduction in the detection rate of Gleason grade group 1 cancers and a 19% reduction in the detection rate of clinically significant prostate cancer.
• Characteristics of Missed Cancers: Missed clinically significant prostate cancers were often smaller than 6 mm (54.5%), of Gleason grade group 2 (67.3%), and considered low risk by clinical nomogram (74.6%). Gleason grade group 1 cancers identified uniquely on systematic biopsy were often contralateral to the MRI target (46.4%), whereas missed clinically significant prostate cancer was predominantly ipsilateral (81%).

Limitations: The study acknowledges that biopsying only men with high-risk clinical features among PI-RADS 1-2 MRI could potentially overestimate the clinically significant prostate cancer detection rate.

This research underscores the importance of the PRECISION biopsy strategy in reducing unnecessary biopsies and improving the detection of clinically significant prostate cancer, while also highlighting the need for careful consideration of the characteristics of cancers that may be missed using this approach.