Evaluating the biopsy-negative prostate lesions based on sequential biparametric prostate magnetic resonance imaging: Can PRECISE be used to guide repeat biopsy?

Abstract

Indications for repeat biopsy after an initial negative prostate biopsy remain poorly defined. Therefore, this study aimed to investigate the effectiveness of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system as a guide for repeat biopsy. We retrospectively reviewed patients who underwent repeat prostate biopsy and had bpMRI performed before both biopsies between 2013 and 2024. The association of clinically significant prostate cancer (csPCa) detection with initial Prostate Imaging Reporting and Data System (PI-RADS) and PRECISE scores was analyzed. The predictive effects of prostate-specific antigen density before repeat biopsy (re-PSAD) and PSA velocity (PSAV) on csPCa were assessed in patients progressing to or maintaining re-PI-RADS 3. 104 individuals were included with a median follow-up period of 28.58 months and a PSAV of 0.90 ng/mL/year (interquartile range (IQR), −0.17 to 2.57 ng/mL/year). The csPCa detection rate at repeat biopsy was 24.0%. 42 participants (40.4%) had PRECISE scores of 4–5, 43 (41.3%) had scores of 3, and 19 (18.3%) had scores of 1–2. A higher PRECISE score corresponds to a higher csPCa detection rate, with csPCa diagnosed in 52.4% of patients with PRECISE scores of 4–5. In subgroup analyses, re-PSAD and PSAV avoided 65.4% and 53.8% of repeat biopsies, respectively, and would have caused 5.9% and 0.00% of missed csPCa. PRECISE may be useful for guiding repeat biopsy decisions and may provide incremental value for predicting csPCa when interpreted together with PI-RADS. Additionally, PSAD and PSAV can assist in screening for repeat biopsy. Question Indications for repeat prostate biopsy after an initial negative result remain poorly defined. Can sequential MRI PRECISE scoring help inform repeat biopsy decisions? Findings In our retrospective cohort, PRECISE 1–2 yielded no clinically significant cancer, while PRECISE 4–5 showed a 52.4% detection rate. PSA parameters aided equivocal cases. Critical relevance statement This study evaluates sequential MRI PRECISE scoring, suggesting its potential to help reduce unnecessary repeat biopsies for regressing lesions while identifying high-risk progressing abnormalities. Question Indications for repeat prostate biopsy after an initial negative result remain poorly defined. Can sequential MRI PRECISE scoring help inform repeat biopsy decisions? Findings In our retrospective cohort, PRECISE 1–2 yielded no clinically significant cancer, while PRECISE 4–5 showed a 52.4% detection rate. PSA parameters aided equivocal cases. Critical relevance statement This study evaluates sequential MRI PRECISE scoring, suggesting its potential to help reduce unnecessary repeat biopsies for regressing lesions while identifying high-risk progressing abnormalities.