Introduction and objectives: European guidelines on prostate cancer strongly recommend multiparametric MRI before prostate biopsy in patients with clinical suspicion of prostate cancer (PCa). This led to a progressive widespread of mpMRI even in small non-academic canters. This could have an impact on mpMRI-targeted biopsy (TB) detection rate, given by possible “false positive targets”. Therefore, we aimed to evaluate the PCa detection rate on TB according to the mpMRI canter’s volume and experience. Material and methods: We retrospectively analyzed data of 737 patients who underwent mpMRI TB at our outpatient clinic for suspicion of PCa, using Toshiba Aplio 500™ mpMRI-TRUS Fusion platform. TB was performed with a transrectal approach, taking 3 biopsy cores targeted to the index lesion. TB were performed by 4 expert urologists. All specimens were processed by dedicated pathologists. Patients were stratified according to the center that performed mpMRI: high volume academic (Hub; >300 mpMRI per year) vs. low volume non-academic (Spoke; <300 mpMRI per year) centers. In each center, all lesions were scored using the PI-RADS-v2. Demographics, clinic, radiologic and pathologic information were available for each patient. Differences in detection rate for any PCa and for clinically significant PCa (csPCa) between the two groups were explored. Multivariable logistic regression was used to evaluate predictors of csPCa on TB. The adjustment for casemix included: age, PSA, mpMRI center (Hub vs. Spoke), lesion’s location, PSA density, PI-RADS-v2 score and index lesion’s size. Results: Overall, 449 (60.9%) and 288 (39.1%) patients underwent mpMRI at a Hub or Spoke center, respectively. Patients in the Hub group were more likely to have a prior negative biopsy (33 vs 20%) or be in active surveillance for PCa (16.3 vs 6.3%; all p≤0.001). Significantly lower rate of PIRADS 3 lesions were reported in Spoke group compared to Hub group (36.1 vs 49%; p <0.001). Patients in Spoke group reported a higher rate of transitional zone lesion compared to Hub group (23.6 vs. 9.4%; p < 0.001). Patients in the Hub group had higher detection rate for both any PCa (60.3 vs 48.1%) and csPCa (46.9 vs 38.7%; all p≤0.001). After stratifying for PI-RADS-v2 score, patients in Hub group had higher detection rate for PI-RADS-v2 score 3 (any PCa 43.6 vs. 28.2% p=0.008 csPCA 25.2 vs. 15.7% p=0.05) and PI-RADS-v2 score 4 (any PCa 74.7 vs. 55% csPCa 65.7 vs. 45.7% p<0.001) compared to patients in Spoke group. At multivariable analyses, mpMRI performed in a Spoke center was found to be an independent predictor for detection of csPCa at TB (OR 0.65; p =0.04) Conclusion: Our study shows that mpMRI performed in Hub centers provided a significantly higher PCa yield on TB. Dedicated radiologists are essential to avoid unnecessary and potentially harmful procedures.

Head-to-head comparison of prostate cancer detection rate at MRI-targeted FUSION biopsy between hub and spoke mpMRI Italian centers.

For 2021, our focus remains: turning new data into your daily practice. The programme will consist of state-of-the-art lectures, case discussions and panel debates. Our faculty is a group of international & multidisciplinary experts.

We will take you on our journey to Ghent and beyond. Prior the congress, we send out case challenges, where you can compare your opinion with peers & experts. These cases will be part of the Global Congresses on Prostate & Bladder Cancer programme during the congress days (12 & 13 October for PROSCA and 14 & 15 October for BLADDR). After these days, you will be updated on prostate & bladder cancer management.