Abstract
Background: The impact of MRI-lesion targeted (TB) and systematic biopsy (SB) Gleason score (GS) as a predictor for final pathological GS still remains unclear. Methods: All patients with TB + SB, and subsequent radical prostatectomy (RP) between 01/2014-12/2020 were analyzed. Rank correlation coefficient predicted concordance with pathological GS for patients’ TB and SB GS, as well as for the combined effect of SB + TB. Results: Of 159 eligible patients, 77% were biopsy naïve. For SB taken in addition to TB, a Spearman’s correlation of +0.33 was observed regarding final GS. Rates of concordance, upgrading, and downgrading were 37.1, 37.1 and 25.8%, respectively. For TB, a +0.52 correlation was computed regarding final GS. Rates of concordance, upgrading and downgrading for TB biopsy GS were 45.9, 33.3, and 20.8%, respectively. For the combination of SB + TB, a correlation of +0.59 was observed. Rates of concordance, upgrading and downgrading were 49.7, 15.1 and 35.2%, respectively. The combined effect of SB + TB resulted in a lower upgrading rate, relative to TB and SB (both p < 0.001), but a higher downgrading rate, relative to TB (p < 0.01). Conclusions: GS obtained from TB provided higher concordance and lower upgrading and downgrading rates, relative to SB GS with regard to final pathology. The combined effect of SB + TB led to the highest concordance rate and the lowest upgrading rate.
Highlights
Prostate cancer is still the most common cancer in men [1,2,3]
Uncertainty as to whether the prediction of pathological Gleason score (GS) should be based on target prostate biopsy (TB) or systematic biopsy (SB) results still remains. We addressed this gap and relied on our institutional prostate biopsy and radical prostatectomy (RP) database to investigate the correlation of TB vs. SB GS within the same patient with pathologic GS
Our study shows that the biopsy GS obtained from TB results has higher concordance and lower upgrading and downgrading rates compared with the SB GS
Summary
Prostate cancer is still the most common cancer in men [1,2,3]. After diagnosis, histological prostate biopsy results are used for clinical decision-making with patients, aiming for potentially curative treatment in localized prostate cancer disease [4]. For clinical decision-making, surgical planning and counseling of patients with the possible need of adjuvant or salvage treatment, or for biochemical recurrence after radical prostatectomy, recommendations are mostly based on biopsy Gleason score (GS) [5]. GS should ideally be concordant with the pathologic GS results after radical prostatectomy to avoid over- or underestimating the disease. Rates of concordance, upgrading and downgrading for TB biopsy GS were 45.9, 33.3, and 20.8%, respectively. Rates of concordance, upgrading and downgrading were 49.7, 15.1 and 35.2%, respectively. The combined effect of SB + TB resulted in a lower upgrading rate, relative to TB and SB (both p < 0.001), but a higher downgrading rate, relative to TB (p < 0.01). Conclusions: GS obtained from TB provided higher concordance and lower upgrading and downgrading rates, relative to SB
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