Résumé
Objective: to assess the predictive factors (clinical, biological and MRI data) that enable identifying men in which a sole targeted biopsy detects the maximal prostate cancer risk group. We hypothesized that randomized biopsies have little therapeutic impact when they have a lower ISUP than targeted ones. Material and method: in a cohort of 144 consecutive patients who underwent a combination of targeted biopsies (by MRI/ultrasound fusion technique) and 12 randomized biopsies between June 2017 and March 2020, we retrospectively recorded clinical (age, digital rectal exam, personal history of prostate biopsy, family history of prostate cancer, ERSPC score 3-4 and 6), biological (PSA and PSA density), and MRI parameters (quantitative and qualitative data on the target and on the off-target area). Two groups of patients were defined based on ISUP scores obtained on targeted and randomized biopsies, and on the length of positive biopsy coverage in case of equal ISUP. We performed univariate and bivariate analysis of all the studied variables to predict in which situation randomized biopsies had an ISUP lower than targeted biopsies. Interobserver agreement analyses were performed on each variable. Results: the mean age of our cohort was 67 years (IQR: 61-72) and the mean PSA level was 9.7 ng/mL (IQR: 5.5 - 11). A total of 30 patients (20.8%) were cancer free. Among the 114 patients with cancer, 85 (74.6%) had a higher ISUP score on targeted biopsies than on randomized ones, while the remaining 29 patients (25.6%) were in the opposite case (ISUP score RB > TB). Of all variables studied, none showed a significant difference between the two groups. Conclusion: we were not able to show any predictive factors to select patients for whom randomized biopsies could be dropped when there was a target on prostate MRI. The combination of targeted biopsies and randomized biopsies should still be required.