A Role For Pre-biopsy Bi-parametric Magnetic Resonance In Repeat Prostate Biopsy

Objective To explore which patients with suspicions for prostate cancer(PCa)need repeat prostate biopsies(rePBx)and what role bi-parametric magnetic resonance imaging(bpMRI)might play in rePBx.Methods We retrospectively examined 120 patients who accepted rePBx in department of urology in the First Affiliated Hospital of Nanjing Medical University from May2018 to August 2020.All patients accepted pre-biopsy bpMRI examination.Systematic biopsy was performed in patients without ROI on bpmri,while targeted biopsy and systematic biopsy were performed in patients with regions of interest(ROIs)[prostate imaging reporting and data system(PI-RADS)version 2.0 score ≥ 3].For those underwent TBx and SBx,only the results of TBx were analyzed.Patients were separated into two groups according to the biopsy outcomes: a clinically significant prostate cancer(CSPC)group and a clinically insignificant prostate cancer(CIPC)or benign group.Baseline characteristics were compared between the two groups.Multivariate logistic regression was applied to find independent risk factors and construct risk model.Results Smaller prostate volume,higher prostate specific antigen(PSA),PSA density(PSAD),smaller free/total PSA ratio,suspicious digital rectal examination(DRE)outcome,higher PI-RADS score and ROIs at the anterior,posterior-apex and lateral portions of prostate were found significantly associated with high risk of CSPC in rePBx patients.Then,DRE outcome,PI-RADS score and location of ROIs were identified as independent risk factors and applied to develop risk model,of which the area under receiver operating characteristic curve was 0.9429.Conclusions We identified the significant role pre-biopsy bpMRI played in rePBx.A risk model was developed based on PI-RADS score,location of ROI and DRE outcome,which showed good prediction performance for CSPC.For patient without suspicious DRE finding,if no ROI was identified or only ROIs at posterior-base and posteriormid portions with PI-RADS score < 4 were found in bpMRI,rePBx could be safely avoided after previous negative biopsy.