Abstract
OBJECTIVE
To assess the impact of concomitant targeted biopsies (TB) for predicting final disease
reclassification in MRI-positive low-risk prostate cancer patients eligible for active
surveillance (AS) on systematic biopsies (SB).
MATERIALS AND METHODS
From a prospective database, we included all prebiopsy MRI-positive men fulfilling
AS criteria at diagnosis (Toronto [n = 114], UCSF [n = 82], or PRIAS [n = 60] criteria) on SB. All patients underwent a combination of SB and software-based
fusion TB, and an immediate radical prostatectomy. The primary endpoints were the
pathologic upgrading and upstaging rates.
RESULTS
Biopsy grade group was upgraded to grade group (GG) 2 and to GG≥3 on TB in 65.9%-76.7%
and in 12.2-16.7%, respectively. The rate of GG ≥3 in radical prostatectomy specimens
varied from 31.6% to 43.3% with no relation between strictest criteria and lower upgrading
rates. The proportion of not organ-confined disease (35%-39%) was comparable among
the AS cohorts. Negative TB was strongly associated with the absence of final GG ≥3.
Tumor grade on TB was significantly correlated with the risk of final GG ≥3 in both
Toronto and UCSF cohorts, not in the PRIAS cohort. In the PRIAS cohort, the only independent
predictive factor for GG ≥3 disease was the maximal tumor length in any core (P = .034).
CONCLUSION
In MRI-positive patients, the risk of disease reclassification was comparable whatever
the SB-based AS criteria used. TB were predictive of final upgrading, with a varied
impact according to the AS criteria. SB features remained relevant for reclassification
prediction even in case of positive TB. The risk of upstaged disease remains important,
approximately one third, and neither TB/SB parameters nor MRI findings could accurately
predict it.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent.Eur Urol. 2017; 71: 618-629
- Active Surveillance for low-risk prostate cancer: The European Association of Urology Position in 2018.Eur Urol. 2018; 74: 357-368
- A decade of active surveillance in the PRIAS Study: an update and evaluation of the criteria used to recommend a switch to active treatment.Eur Urol. 2016; 70: 954-960
- Extended followup and risk factors for disease reclassification in a large active surveillance cohort for localized prostate cancer.J Urol. 2015; 193: 807-811
- Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies?.World J Urol. 2018; https://doi.org/10.1007/s00345-018-2399
- A Novel nomogram to identify candidates for extended pelvic lymph node dissection among patients with clinically localized prostate cancer diagnosed with magnetic resonance imaging-targeted and systematic biopsies.Eur Urol. 2018; (pii:S0302-2838)
- MRI-Targeted or standard biopsy for prostate-cancer diagnosis.N Engl J Med. 2018; 378: 1767-1777
- Active surveillance magnetic resonance imaging study (ASIST): results of a randomized multicenter prospective trial.Eur Urol. 2018; https://doi.org/10.1016/j.eururo.2018.06.025
- Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.J Clin Oncol. 2015; 33: 272-277
- Refined analysis of prostate-specific antigen kinetics to predict prostate cancer active surveillance outcomes.Eur Urol. 2018; 74: 211-217
- ESUR prostate MR guidelines 2012.Eur Radiol. 2012; 22: 746-757
- A nomogram for predicting low-volume/low-grade prostate cancer: a tool in selecting patients for active surveillance.Cancer. 2007; 110: 2441-2447
- Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram.J Urol. 2007; 177: 107-112
- Targeted prostate biopsy in select men for active surveillance: do the Epstein criteria still apply?.J Urol. 2014; 192: 385-390
- Refining the risk-stratification of transrectal biopsy-detected prostate cancer by elastic fusion registration transperineal biopsies.World J Urol. 2018; https://doi.org/10.1007/s00345-018-2459-4
- Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: a prospective cohort study.J Urol. 2012; 187: 1247-1252
- A multicentric study on accurate grading of prostate cancer with systematic and MRI/US fusion targeted biopsies: comparison with final histopathology after radical prostatectomy.World J Urol. 2019; https://doi.org/10.1007/s00345-019-02634-9
- Impact of multiparametric MRI and MRI-targeted biopsy on pre-therapeutic risk assessment in prostate cancer patients candidate for radical prostatectomy.World J Urol. 2018; https://doi.org/10.1007/s00345-018-2360-1
- Targeted prostate biopsy in the era of active surveillance.Urology. 2018; 112: 12-19
- Precision matters in MR Imaging-targeted prostate biopsies: evidence from a prospective study of cognitive and elastic fusion registration transrectal biopsies.Radiology. 2018; 287: 534-542
Article info
Publication history
Published online: December 30, 2019
Accepted:
October 9,
2019
Received:
June 3,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
