Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts MP1-04 Should PI-RADS 2 Lesions Be Biopsied or Watched? L. O’Connor; A. Wang; N. Yerram; G. Hale; A. Lebastchi; M. Merino; P. Choyke; B. Turkbey; B. Wood; P. Pinto National Cancer Institute, National Institutes of Health, Bethesda, MD, USA Introduction: Prostate Imaging and Reporting Data Systems (PI-RADS) allows clinicians to assess the risk of clinically significant cancer prior to biopsy. Based on current recommendations, many urologists choose to only biopsy PI-RADS 3 lesions or greater. However, there is very limited biopsy data on PI-RADS 2 lesions. In this study we report our experience of biopsies for PI-RADS 2 lesions. Materials &Methods: Our institutional database was queried for all patients who received an MRI/Transrectal Ultrasound (TRUS) fusion-guided prostate biopsy (Fbx) from 2014-2017. All patients with PI-RADS 2 lesions were identified. MRI data as well as pathology results from biopsy were recorded on a per lesion basis. Results: A total of 963 patients underwent Fbx from 2014-2017 at our institution. 272 patients were identified as having at least one PI-RADS 2 lesion on mpMRI, resulting in a total of 372 biopsied PI-RADS 2 lesions. The median diameter of each lesion on mpMRI was 9 mm (IQR 6-11). Overall, 79/372 lesions (27.0%) had a result of Gleason Grade group (GG) 1 or higher on biopsy. Of these lesions, 51/79 (64.6%) had GG1 disease, 20/79 (25.3%) had GG2 disease, and 8/79 (10.1%) had ≥ GG3 disease. Overall, clinically significant cancer (defined as GG2 or greater) was detected in 28/372 (7.5%) lesions using a targeted biopsy approach. Further, when the PI-RADS 2 lesion was identified as the index lesion, clinically significant cancer was detected by systematic biopsy in 10/109 (9.2%) patients. Conclusions: The results from our study support that PI-RADS 2 lesions carry a low likelihood of detecting clinically significant cancer on prostate biopsy. As biopsy data on PI-RADS 2 lesions is sparse, further study is need to answer this important clinical question. Cognitive MRI Transperineal Prostate Biopsy Diagnostic Rates Do Not Differ From MRI-Fusion Transrectal Biopsy Diagnostic Rates K. Lim 1 ; M. Davis 1 ; F. Carvalho 1 ; T. Sholklapper 2 ; L.A. Galloway 2 ; L. Stamatakis 3 ; R. Hankins 1 ; J. Lynch 1 ; J. Hwang 3 ; R. Krasnow 3 ; K. Kowalczyk 1 1 MedStar Georgetown University Hospital, Washington, DC, USA; 2 Georgetown University School of Medicine, Washington, DC, USA; 3 MedStar Washington Hospital Center, Washington, DC, USA Introduction: Transperineal biopsy (TPB) offers an alternative to transrectal ultrasound prostate biopsy (TRUS) with lower infection risk. However, MRI-fusion software with TPB is not as widely available and requires upgrades to become TPB compatible. TPB templates allow for more complete sampling of the prostate. We hypothesize that cognitive MRI TPB prostate cancer detection rates are similar to those of MRI-TRUS fusion biopsies (TRUS-FB). Materials &Methods: Data was collected in a prospective IRB-approved database and analyzed retrospectively. Men undergoing TRUS-FB and TPB were identified. Prostate cancer diagnosis and diagnosis by Gleason group (GG) and PIRADS score were compared in men undergoing standard TPB, cognitive TPB, and TRUS-FB. Differences between groups were analyzed with Wilcoxon rank-sum test with statistical significance of p < 0.05. Results: From 2013-2020, 214 TPB and 228 TRUS-FB were performed. Among TPB, 136 were cognitive with prior suspicious MRI. Prior MRI vs. no MRI did not change prostate cancer detection for TPB (72.6% vs. 73.1%, p=0.873). Detection rates remained similar among GGs. When comparing TRUS-FB vs. cognitive TPB, there were no differences in prostate cancer detection (71.9% vs. 72.6%, p = 0.978) with similar mean GGs detected between groups, and no differences in prostate cancer detection when broken down by PIRADS score. Conclusions: TPB has a high prostate cancer diagnosis rate with or without prior MRI. Prostate cancer detection rates for cognitive TPB are the same as TRUS-FBwith no difference in GGs. While MRI is an invaluable tool for prostate cancer diagnosis and treatment, fusion software may not be necessary for accurate diagnosis when performing TPB. MP1-03 15 Poster Session 1: Diagnostic Imaging and Risk Stratification in Cancer