264 Negative Biopsies in the Presence of PI-RADS 4/5 Lesions – Do We Need a National Standardized Protocol?

Published Date: 19th June 2025

Publication Authors: Robinson. AS, Uwadiae. H, Khadr. RN, Athmanatha. N, Mistry. R

Aim
The Rapid Diagnostic Service (RDS) facilitates prostate cancer diagnosis by expediting biopsies following multiparametric magnetic resonance imaging (mpMRI). This audit evaluates RDS outcomes for PI-RADS 4–5 lesions but negative biopsies, examining adherence to clinical standards and the need for a standardized protocol.

Method
A retrospective review of 343 patients referred to RDS from November 2023 to May 2024, with up to 12 months of follow-up, was conducted. Positive mpMRI findings were defined as PI-RADS 4-5. Patients with benign biopsies were assessed for biopsy adequacy, MDT review and PI-RADS score revisions.

Results
Of 343 patients, 57 had benign biopsy results. Among them, 54% (n=31) had PI-RADS 4–5 lesions, and 46% (n=26) had PI-RADS 1–3. For PI-RADS 4–5, the MDT review led to a PI-RADS score revision of 42% (n=13; 12 downgraded, 1 upgraded). Management included PSA monitoring (n=17), repeat mpMRI (n=5), repeat biopsy (n=3), antibiotics with repeat PSA (n=2), and discharge (n=4). For PI-RADS 1–3 (n=26), outcomes included MDT review (n=10), consultant review (n=11), registrar review (n=3), and nurse specialist review (n=3). None of the 57 patients were diagnosed with prostate cancer during follow-up.

Conclusions
Adherence to MDT review for PI-RADS 4–5 lesions ensure diagnostic accuracy and highlights the role of urology-specialized radiologists in score accuracy. MDT discussions for PI-RADS 3 lesions require further investigation. Multi-centred studies will corroborate our findings and evaluate longer-term outcomes in conservatively managed patients. Standardized protocols for managing PI-RADS 4–5 lesions with negative biopsies are needed for patient safety and care consistency.

 

Robinson, A; Uwadiae, H; Khadr, R; Athmanatha, N; Mistry, R. (2025). 264 Negative Biopsies in the Presence of PI-RADS 4/5 Lesions – Do We Need a National Standardized Protocol?. BJS. 112(Suppl 10), p.znaf128.228. [Online]. Available at: https://dx.doi.org/10.1093/bjs/znaf128.228 [Accessed 1 August 2025].

 

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