Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection

Fabio Zattoni; Giorgio Gandaglia; Roderick C.N. van den Bergh; Giancarlo Marra; Massimo Valerio; Alberto Martini; Jonathan Olivier; Ignacio Puche – SanzI; Pawel Rajwa; Martina Maggi; Riccardo Campi; Rossella Nicoletti; Daniele Amparore; Sabrina De Cillis; Junlong Zhuang; Hongqian Guo; Andrea Fuschi; Alessandro Veccia; Francesco Ditonno; Leonor J. Paulino Pereira; Alessandro Marquis; Francesco Barletta; Riccardo Leni; Veeru Kasivisvanathan; Alessandro Antonelli; Juan Gomez Rivas; Sebastiaan Remmers; Monique J. Roobol; Alberto Briganti; Fabrizio Dal Moro; Giacomo Novara

doi:10.1038/s41391-024-00904-1

Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection

Fabio Zattoni^*
, Giorgio Gandaglia
, Roderick C.N. van den Bergh
, Giancarlo Marra
, Massimo Valerio
, Alberto Martini
, Jonathan Olivier
, Ignacio Puche – SanzI
, Pawel Rajwa
, Martina Maggi
, Riccardo Campi
, Rossella Nicoletti
, Daniele Amparore
, Sabrina De Cillis
, Junlong Zhuang
, Hongqian Guo
, Andrea Fuschi
, Alessandro Veccia
, Francesco Ditonno
, Leonor J. Paulino Pereira

Alessandro Marquis, Francesco Barletta, Riccardo Leni, Veeru Kasivisvanathan, Alessandro Antonelli, Juan Gomez Rivas, Sebastiaan Remmers, Monique J. Roobol, Alberto Briganti, Fabrizio Dal Moro, Giacomo Novara

^*Corresponding author for this work

Urology

University of Padua
IRCCS Ospedale San Raffaele
Division of Oncology
University of Turin
University of Geneva
Université de Lille
Department of Urology
Hospital Universitario Virgen de las Nieves
Medical University of Vienna
Medical Centre for Postgraduate Education, Warsaw
Medical University of Silesia in Katowice
University of Rome La Sapienza
Department of Maternal – Infant and Urological Sciences
Urology Unit
University of Florence
Nanjing University
People’s Republic of China
IRCCS Fondazione Ca'Granda – Ospedale Maggiore Policlinico - Milano
St. Antonius Ziekenhuis
University College London
Hospital Clínico San Carlos de Madrid
Oncology and Gastroenterology

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

Abstract

Purpose:

To investigate the detection and predictors of prostate cancer (PCA) and clinically significant prostate cancer (csPCA) in patients with positive multiparametric MRI (mpMRI) followed by a negative MRI – guided target biopsy (TB) and systematic biopsy (SB).

Materials and methods:

This retrospective multicenter study included 694 patients from 10 tertiary referral centers with an initial positive mpMRI (PI-RADS ≥ 3) and negative results on both MRI-TB and SB. Patients were classified into three groups based on follow-up: Group 1 (prostate re-biopsy without new mpMRI), Group 2 (standardized second prostate mpMRI and subsequent re-biopsy), and Group 3 (follow-up with mpMRIs and biopsy based on clinical and radiological triggers). The primary outcomes were the detection of any PCA and csPCA during follow up. Study groups were compared according to their probability of PCA and csPCA assessed with the ERSPC-MRI risk calculator. Statistical analysis included Kaplan – Meier analysis, Cox regression, and multivariable analysis for the detection of (cs)PCa.

Results:

The overall detection of PCA and csPCA was 26.8% and 19.3%, respectively, with varying rates in different PI-RADS groups. Group 3 had the highest 2-year and 5-year PCA–free survival (94 and 84%) and csPCA – free survival (96 and 86%). Multivariable analysis revealed a significantly higher risk of PCA and csPCA in Group 1 and 2 compared to Group 3 (p < 0.01). Clinical and radiological predictors for PCA and csPCA included higher age, prostate volume, PI-RADS score, the presence of atypical small acinar proliferation (ASAP), and a smaller number of TB and SB performed during the initial biopsy. Study limitations, include the retrospective design and reliance on clinical and radiological triggers for follow–up decisions.

Conclusions:

Patients with positive mpMRI but negative TB and SB results exhibit varying rates of PCA and csPCA depending on the follow up scheme. Tailored follow-up strategies are essential for optimal management in this clinical scenario.

Original language	English
Pages (from-to)	435-443
Number of pages	9
Journal	Prostate Cancer and Prostatic Diseases
Volume	28
Issue number	2
DOIs	https://doi.org/10.1038/s41391-024-00904-1
Publication status	Published - Jun 2025

Bibliographical note

Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature Limited 2024.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1038/s41391-024-00904-1

Cite this

Zattoni, F., Gandaglia, G., van den Bergh, R. C. N., Marra, G., Valerio, M., Martini, A., Olivier, J., Puche – SanzI, I., Rajwa, P., Maggi, M., Campi, R., Nicoletti, R., Amparore, D., De Cillis, S., Zhuang, J., Guo, H., Fuschi, A., Veccia, A., Ditonno, F., ... Novara, G. (2025). Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection. Prostate Cancer and Prostatic Diseases, 28(2), 435-443. https://doi.org/10.1038/s41391-024-00904-1

@article{c7522d2f542046f088b02a191c814b98,

title = "Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection",

abstract = "Purpose: To investigate the detection and predictors of prostate cancer (PCA) and clinically significant prostate cancer (csPCA) in patients with positive multiparametric MRI (mpMRI) followed by a negative MRI – guided target biopsy (TB) and systematic biopsy (SB). Materials and methods: This retrospective multicenter study included 694 patients from 10 tertiary referral centers with an initial positive mpMRI (PI-RADS ≥ 3) and negative results on both MRI-TB and SB. Patients were classified into three groups based on follow-up: Group 1 (prostate re-biopsy without new mpMRI), Group 2 (standardized second prostate mpMRI and subsequent re-biopsy), and Group 3 (follow-up with mpMRIs and biopsy based on clinical and radiological triggers). The primary outcomes were the detection of any PCA and csPCA during follow up. Study groups were compared according to their probability of PCA and csPCA assessed with the ERSPC-MRI risk calculator. Statistical analysis included Kaplan – Meier analysis, Cox regression, and multivariable analysis for the detection of (cs)PCa. Results: The overall detection of PCA and csPCA was 26.8\% and 19.3\%, respectively, with varying rates in different PI-RADS groups. Group 3 had the highest 2-year and 5-year PCA–free survival (94 and 84\%) and csPCA – free survival (96 and 86\%). Multivariable analysis revealed a significantly higher risk of PCA and csPCA in Group 1 and 2 compared to Group 3 (p < 0.01). Clinical and radiological predictors for PCA and csPCA included higher age, prostate volume, PI-RADS score, the presence of atypical small acinar proliferation (ASAP), and a smaller number of TB and SB performed during the initial biopsy. Study limitations, include the retrospective design and reliance on clinical and radiological triggers for follow–up decisions. Conclusions: Patients with positive mpMRI but negative TB and SB results exhibit varying rates of PCA and csPCA depending on the follow up scheme. Tailored follow-up strategies are essential for optimal management in this clinical scenario.",

author = "Fabio Zattoni and Giorgio Gandaglia and \{van den Bergh\}, \{Roderick C.N.\} and Giancarlo Marra and Massimo Valerio and Alberto Martini and Jonathan Olivier and \{Puche – SanzI\}, Ignacio and Pawel Rajwa and Martina Maggi and Riccardo Campi and Rossella Nicoletti and Daniele Amparore and \{De Cillis\}, Sabrina and Junlong Zhuang and Hongqian Guo and Andrea Fuschi and Alessandro Veccia and Francesco Ditonno and \{Paulino Pereira\}, \{Leonor J.\} and Alessandro Marquis and Francesco Barletta and Riccardo Leni and Veeru Kasivisvanathan and Alessandro Antonelli and Rivas, \{Juan Gomez\} and Sebastiaan Remmers and Roobol, \{Monique J.\} and Alberto Briganti and \{Dal Moro\}, Fabrizio and Giacomo Novara",

note = "Publisher Copyright: {\textcopyright} The Author(s), under exclusive licence to Springer Nature Limited 2024.",

year = "2025",

month = jun,

doi = "10.1038/s41391-024-00904-1",

language = "English",

volume = "28",

pages = "435--443",

journal = "Prostate Cancer and Prostatic Diseases",

issn = "1365-7852",

publisher = "Springer Nature",

number = "2",

}

Zattoni, F, Gandaglia, G, van den Bergh, RCN, Marra, G, Valerio, M, Martini, A, Olivier, J, Puche – SanzI, I, Rajwa, P, Maggi, M, Campi, R, Nicoletti, R, Amparore, D, De Cillis, S, Zhuang, J, Guo, H, Fuschi, A, Veccia, A, Ditonno, F, Paulino Pereira, LJ, Marquis, A, Barletta, F, Leni, R, Kasivisvanathan, V, Antonelli, A, Rivas, JG, Remmers, S , Roobol, MJ, Briganti, A, Dal Moro, F & Novara, G 2025, 'Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection', Prostate Cancer and Prostatic Diseases, vol. 28, no. 2, pp. 435-443. https://doi.org/10.1038/s41391-024-00904-1

Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection. / Zattoni, Fabio; Gandaglia, Giorgio; van den Bergh, Roderick C.N. et al.
In: Prostate Cancer and Prostatic Diseases, Vol. 28, No. 2, 06.2025, p. 435-443.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection

AU - Zattoni, Fabio

AU - Gandaglia, Giorgio

AU - van den Bergh, Roderick C.N.

AU - Marra, Giancarlo

AU - Valerio, Massimo

AU - Martini, Alberto

AU - Olivier, Jonathan

AU - Puche – SanzI, Ignacio

AU - Rajwa, Pawel

AU - Maggi, Martina

AU - Campi, Riccardo

AU - Nicoletti, Rossella

AU - Amparore, Daniele

AU - De Cillis, Sabrina

AU - Zhuang, Junlong

AU - Guo, Hongqian

AU - Fuschi, Andrea

AU - Veccia, Alessandro

AU - Ditonno, Francesco

AU - Paulino Pereira, Leonor J.

AU - Marquis, Alessandro

AU - Barletta, Francesco

AU - Leni, Riccardo

AU - Kasivisvanathan, Veeru

AU - Antonelli, Alessandro

AU - Rivas, Juan Gomez

AU - Remmers, Sebastiaan

AU - Roobol, Monique J.

AU - Briganti, Alberto

AU - Dal Moro, Fabrizio

AU - Novara, Giacomo

PY - 2025/6

Y1 - 2025/6

N2 - Purpose: To investigate the detection and predictors of prostate cancer (PCA) and clinically significant prostate cancer (csPCA) in patients with positive multiparametric MRI (mpMRI) followed by a negative MRI – guided target biopsy (TB) and systematic biopsy (SB). Materials and methods: This retrospective multicenter study included 694 patients from 10 tertiary referral centers with an initial positive mpMRI (PI-RADS ≥ 3) and negative results on both MRI-TB and SB. Patients were classified into three groups based on follow-up: Group 1 (prostate re-biopsy without new mpMRI), Group 2 (standardized second prostate mpMRI and subsequent re-biopsy), and Group 3 (follow-up with mpMRIs and biopsy based on clinical and radiological triggers). The primary outcomes were the detection of any PCA and csPCA during follow up. Study groups were compared according to their probability of PCA and csPCA assessed with the ERSPC-MRI risk calculator. Statistical analysis included Kaplan – Meier analysis, Cox regression, and multivariable analysis for the detection of (cs)PCa. Results: The overall detection of PCA and csPCA was 26.8% and 19.3%, respectively, with varying rates in different PI-RADS groups. Group 3 had the highest 2-year and 5-year PCA–free survival (94 and 84%) and csPCA – free survival (96 and 86%). Multivariable analysis revealed a significantly higher risk of PCA and csPCA in Group 1 and 2 compared to Group 3 (p < 0.01). Clinical and radiological predictors for PCA and csPCA included higher age, prostate volume, PI-RADS score, the presence of atypical small acinar proliferation (ASAP), and a smaller number of TB and SB performed during the initial biopsy. Study limitations, include the retrospective design and reliance on clinical and radiological triggers for follow–up decisions. Conclusions: Patients with positive mpMRI but negative TB and SB results exhibit varying rates of PCA and csPCA depending on the follow up scheme. Tailored follow-up strategies are essential for optimal management in this clinical scenario.

AB - Purpose: To investigate the detection and predictors of prostate cancer (PCA) and clinically significant prostate cancer (csPCA) in patients with positive multiparametric MRI (mpMRI) followed by a negative MRI – guided target biopsy (TB) and systematic biopsy (SB). Materials and methods: This retrospective multicenter study included 694 patients from 10 tertiary referral centers with an initial positive mpMRI (PI-RADS ≥ 3) and negative results on both MRI-TB and SB. Patients were classified into three groups based on follow-up: Group 1 (prostate re-biopsy without new mpMRI), Group 2 (standardized second prostate mpMRI and subsequent re-biopsy), and Group 3 (follow-up with mpMRIs and biopsy based on clinical and radiological triggers). The primary outcomes were the detection of any PCA and csPCA during follow up. Study groups were compared according to their probability of PCA and csPCA assessed with the ERSPC-MRI risk calculator. Statistical analysis included Kaplan – Meier analysis, Cox regression, and multivariable analysis for the detection of (cs)PCa. Results: The overall detection of PCA and csPCA was 26.8% and 19.3%, respectively, with varying rates in different PI-RADS groups. Group 3 had the highest 2-year and 5-year PCA–free survival (94 and 84%) and csPCA – free survival (96 and 86%). Multivariable analysis revealed a significantly higher risk of PCA and csPCA in Group 1 and 2 compared to Group 3 (p < 0.01). Clinical and radiological predictors for PCA and csPCA included higher age, prostate volume, PI-RADS score, the presence of atypical small acinar proliferation (ASAP), and a smaller number of TB and SB performed during the initial biopsy. Study limitations, include the retrospective design and reliance on clinical and radiological triggers for follow–up decisions. Conclusions: Patients with positive mpMRI but negative TB and SB results exhibit varying rates of PCA and csPCA depending on the follow up scheme. Tailored follow-up strategies are essential for optimal management in this clinical scenario.

UR - https://www.scopus.com/pages/publications/85207033829

U2 - 10.1038/s41391-024-00904-1

DO - 10.1038/s41391-024-00904-1

M3 - Article

C2 - 39501078

AN - SCOPUS:85207033829

SN - 1365-7852

VL - 28

SP - 435

EP - 443

JO - Prostate Cancer and Prostatic Diseases

JF - Prostate Cancer and Prostatic Diseases

IS - 2

ER -

Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions – an EAU-YAU study enhancing prostate cancer detection

Abstract

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