Abstract

Background and objectives: Systematic prostate biopsy (SB) has a low Gleason group (GG) accuracy when compared to final pathology. This may negatively impact the inclusion of patients into specific risk groups and treatment choice. The aim of our study was to assess the GG accuracy of magnetic resonance imaging-ultrasound (MRI-US) fusion prostate biopsy. Materials and Methods: Of a cohort of minimally invasive radical prostatectomy (RP), we selected all patients who were diagnosed with prostate cancer (PCa) via MRI-US fusion biopsy (n = 115). Results: Combined biopsy had the highest rate for GG concordance (61.7% vs. 60.4% for SB vs. 45.3% for MRI-US fusion biopsy) and the lowest for upgrading (20.9% vs. 24.5% for SB vs. 34.9% for MRI-US fusion biopsy), p < 0.0001. No clinical data were predictive for upgrading or downgrading at final pathology. Locally advanced PCa was associated with a high Prostate Imaging-Reporting and Data System (PIRADS) score (p = 0.0014) and higher percentages of positive biopsy cores (PBC)/targeted (p = 0.0002) and PBC/total (p = 0.01). Positive surgical margins were correlated with higher percentages of PBC/systematic (p = 0.003) and PBC/total (p = 0.009). Conclusions: Pre-biopsy prostate MRI improves GG concordance between biopsy and RP. Combined biopsy provides the highest grading accuracy when compared to final pathology. Targeted and systematic biopsy data are predictive for adverse pathologic outcomes.

Highlights

  • Until recently, systematic ultrasound-guided prostate biopsy was considered the gold standard for prostate cancer (PCa) diagnosis

  • Our study shows that the addition of Magnetic resonance imaging (MRI)-targeted biopsy cores to systematic biopsy improves the concordance rate between prostate biopsy and radical prostatectomy (RP) specimen

  • Lower rates of upgrading were seen for combined biopsy, whereas a higher downgrading rate was observed for magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy when compared with a systematic or combined approach

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Summary

Introduction

Systematic ultrasound-guided prostate biopsy was considered the gold standard for prostate cancer (PCa) diagnosis. It entails the sampling of the whole prostate, it is hampered by a low sensitivity and specificity for the detection of PCa [1]. A recent retrospective analysis of a large cohort (17,598 patients) showed a 25.5% rate of upgrading and 15.6% rate of downgrading when comparing systematic biopsy to radical. This may negatively impact the inclusion of patients into specific risk groups and treatment choice. Materials and Methods: Of a cohort of minimally invasive radical prostatectomy (RP), we selected all patients who were diagnosed with prostate cancer (PCa) via MRI-US fusion biopsy (n = 115).

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