Can We Omit Systematic Biopsies in Men with a Positive MRI During Repeat Biopsies for Active Surveillance for Prostate Cancer? Results from the PRIAS Study.
11 affiliations
- 1Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
- 2Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
- 3Department of Urology, Hospital Universitario de Navarra, Pamplona, Spain.
- 4Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
- 5Department of Urology, University Hospital Muenster, Muenster, Germany.
- 6Department of Urology, Helsinki University Hospital, Helsinki, Finland.
- 7Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
- 8Department of Urology, Polyclinique Reims-Bezannes, Bezannes, France.
- 9Department of Urology, Kagawa University, Kagawa, Japan.
- 10Department of Urology and Neurology, Marien Hospital Herne, Herne, Germany.
- 11Department of Urology, Sint Franciscus Hospital, Rotterdam, The Netherlands.
Abstract
Background and objective
This study evaluated the added value of systematic biopsies (SBx) in addition to targeted biopsies (TBx) for detecting upgrading during repeat biopsies on active surveillance (AS) using data from the Prostate Cancer Research International Active Surveillance study.Methods
We analyzed repeat biopsies of men who underwent magnetic resonance imaging (MRI) and SBx at diagnosis, with or without TBx depending on the presence of an MRI lesion, had at least one positive (Prostate Imaging Reporting and Data System 3-5) follow-up MRI, and received both SBx + TBx at subsequent repeat biopsy. Upgrading compared with diagnostic biopsy was assessed for TBx only, SBx only, and both, using three definitions: any upgrading, upgrading to grade group (GG) ≥2 with cribriform growth or intraductal carcinoma (≥GG2+), and upgrading to ≥GG3. Cumulative incidences were calculated using each detection method as competing events. For upgrading ≥GG2+ detected by SBx only, the laterality relative to the MRI lesion was determined.Key findings and limitations
We analyzed 650 repeat biopsies in 568 patients with a median follow-up of 3.0 yr (interquartile range = 1.8-4.3) for men still on AS. During available follow-up, any upgrading occurred in 238 biopsies (37%), of which 47 (7.2%) were detected by SBx only. Upgrading to ≥GG2+ and ≥GG3 was observed in 100 biopsies (16%) and 78 biopsies (12%), respectively, with SBx alone identifying 19 (3.0%) and 15 (2.3%) of these patients. At 6 yr, the cumulative incidence of ≥GG2+ upgrading was 27% (95% confidence interval [CI] = 21-32%), with 5.4% (95% CI = 2.9-9.1%) for upgrading detected exclusively by SBx. Three of the 19 cases with upgrading to ≥GG2+ detected by SBx only were located contralateral to the MRI lesion (0.5% of all biopsies). Limitations include the retrospective design, which may introduce selection and registration biases.Conclusions and clinical implications
In men on AS who underwent diagnostic MRI with SBx (with or without TBx) and a positive follow-up MRI, SBx has limited added value during repeat biopsies, particularly for contralateral sampling, supporting a targeted and perilesional biopsy approach.
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BibTeX
@article{lodder2026omit,
title = {{Can We Omit Systematic Biopsies in Men with a Positive MRI During Repeat Biopsies for Active Surveillance for Prostate Cancer? Results from the PRIAS Study.}},
author = {Jeroen J Lodder and Sebastiaan Remmers and Markus Graefen and Francisco Lozano-Uruñuela and Cristina Marenghi and Philipp Papavassilis and Antti Rannikko and Diederik Somford and Frederic Staerman and Mikio Sugimoto and Karl H Tully and Roderick C N van den Bergh and Monique J Roobol and Prostate Cancer Research International: Active Surveillance (PRIAS) consortium},
journal = {European urology open science},
year = {2026},
month = oct,
doi = {10.1016/j.euros.2026.09.006},
url = {https://europepmc.org/article/MED/42909178},
note = {CC BY},
}
RIS
TY - JOUR
TI - Can We Omit Systematic Biopsies in Men with a Positive MRI During Repeat Biopsies for Active Surveillance for Prostate Cancer? Results from the PRIAS Study.
AU - Jeroen J Lodder
AU - Sebastiaan Remmers
AU - Markus Graefen
AU - Francisco Lozano-Uruñuela
AU - Cristina Marenghi
AU - Philipp Papavassilis
AU - Antti Rannikko
AU - Diederik Somford
AU - Frederic Staerman
AU - Mikio Sugimoto
AU - Karl H Tully
AU - Roderick C N van den Bergh
AU - Monique J Roobol
AU - Prostate Cancer Research International: Active Surveillance (PRIAS) consortium
PY - 2026
DA - 2026/10/13
JO - European urology open science
DO - 10.1016/j.euros.2026.09.006
UR - https://europepmc.org/article/MED/42909178
AB - Background and objective This study evaluated the added value of systematic biopsies (SBx) in addition to targeted biopsies (TBx) for detecting upgrading during repeat biopsies on active surveillance (AS) using data from the Prostate Cancer Research International Active Surveillance study.Methods We analyzed repeat biopsies of men who underwent magnetic resonance imaging (MRI) and SBx at diagnosis, with or without TBx depending on the presence of an MRI lesion, had at least one positive (Prostate Imaging Reporting and Data System 3-5) follow-up MRI, and received both SBx + TBx at subsequent repeat biopsy. Upgrading compared with diagnostic biopsy was assessed for TBx only, SBx only, and both, using three definitions: any upgrading, upgrading to grade group (GG) ≥2 with cribriform growth or intraductal carcinoma (≥GG2+), and upgrading to ≥GG3. Cumulative incidences were calculated using each detection method as competing events. For upgrading ≥GG2+ detected by SBx only, the laterality relative to the MRI lesion was determined.Key findings and limitations We analyzed 650 repeat biopsies in 568 patients with a median follow-up of 3.0 yr (interquartile range = 1.8-4.3) for men still on AS. During available follow-up, any upgrading occurred in 238 biopsies (37%), of which 47 (7.2%) were detected by SBx only. Upgrading to ≥GG2+ and ≥GG3 was observed in 100 biopsies (16%) and 78 biopsies (12%), respectively, with SBx alone identifying 19 (3.0%) and 15 (2.3%) of these patients. At 6 yr, the cumulative incidence of ≥GG2+ upgrading was 27% (95% confidence interval [CI] = 21-32%), with 5.4% (95% CI = 2.9-9.1%) for upgrading detected exclusively by SBx. Three of the 19 cases with upgrading to ≥GG2+ detected by SBx only were located contralateral to the MRI lesion (0.5% of all biopsies). Limitations include the retrospective design, which may introduce selection and registration biases.Conclusions and clinical implications In men on AS who underwent diagnostic MRI with SBx (with or without TBx) and a positive follow-up MRI, SBx has limited added value during repeat biopsies, particularly for contralateral sampling, supporting a targeted and perilesional biopsy approach.
SN - 2666-1691
SN - 2666-1683
ER -