Effect of information on prostate biopsy history on biopsy outcomes in the era of MRI-targeted biopsies

Purpose To describe the predictive value of information on previous benign biopsy for the outcome of MRI-targeted biopsies. Methods An exploratory analysis was conducted using data from a prospective, multicenter, paired diagnostic study of 532 men undergoing diagnostics for prostate cancer during 2016-2017. All men underwent 1.5 T MRI; systematic prostate biopsies; and MRI-targeted biopsies to MRI lesions with Prostate Imaging Reporting and Data System version 2, PI-RADS >= 3. The main outcome was numbers of detected prostate cancer characterized by grade group (GG) where GG >= 2 defined clinically significant cancer (csPCa). Results Men with previous biopsies had significantly more often negative MRI (26% vs. 17%,p < 0.05) compared to men without previous biopsies. Men with previous biopsies showed higher rates of benign biopsies (41% vs. 26%,p < 0.05) and lower rates of GG2 (17% vs. 30%,p < 0.05) and GG >= 3 (5% vs. 10%,p < 0.05) cancer. Biopsy-naive men had higher proportions of highly suspicious MRI lesions (PIRADS 5;p < 0.05) and a higher proportion of significant cancer in those lesions (p = 0.05). In multivariate regression analysis, a previous benign prostate biopsy was associated with less than half the odds of csPCa (OR 0.38; 95% CI 0.20-0.71). Conclusion In this large prospective multicenter trial, we showed that men with a previous prostate biopsy had higher proportions of MRIs without lesions and lower proportion of highly suspicious lesions than biopsy-naive men. Further, biopsy-naive men showed higher detection of clinically significant cancer when using MRI-targeted biopsies. Also, in the era of MRI-targeted biopsy strategies, biopsy history should be carefully considered in biopsy decisions.