Abstract
Biopsy proven Gleason score is essential to decide treatment modalities for prostate cancer, either surgical (radical prostatectomy) or non-surgical (active surveillance, watchful waiting, radiation therapy and hormone therapy). Several studies indicated that biopsy proven Gleason score may underestimate Gleason score at radical prostatectomy, hence we aimed to calculate the minimum length of biopsy cores needed to have Gleason score agreement. We evaluated 115 prostate cancer patients who underwent multiparametric magnetic resonance/transperineal ultrasonography fusion biopsy and subsequently, radical prostatectomy. Biopsy proven Gleason score was consistent with Gleason score at subsequent radical prostatectomy in 82.6% of patients, while in 17.4% of patients, Gleason score was higher at radical prostatectomy. Gleason score agreement showed a strong direct association with a ratio > 0.05 between the total volume of biopsies performed in tumor area and the volume of the corresponding tumor at radical prostatectomy. A significant association was also found with a ratio ≥ 0.0034 between the tumor volume in the biopsy and the volume of the corresponding tumor at radical prostatectomy and with a ratio ≥ 0.086 between the tumor volume in the biopsy and the total volume of biopsies performed in the tumor area. These results could be exploited to calculate the minimum length of biopsy cores needed to have a correct Gleason score estimation and therefore be used in fusion targeted biopsies with volume adjustments.
Highlights
IntroductionProstate cancer (PCa) is the second most frequent malignancy (after lung cancer) in men and the fifth leading cause of death worldwide [1]
Prostate cancer (PCa) is the second most frequent malignancy in men and the fifth leading cause of death worldwide [1]
Our results suggested that a biopsies performed in tumor area (BTA)/tumor volume (TV) ratio > 0.05 represents the best cut-off score in the prediction of a correct Gleason score (GS) (p < 0.001; AUC = 0.834; 95% CI (Confidence Interval) from 0.753 to 0.897; Youden index J = 0.7368; Sensitivity 73.68%; Specificity 100%; Figure 1a and Supplementary Table S1), while a overall tumor volume in the biopsies (BTV)/TV ratio ≥ 0.0034 has been identified as the best cut-off score in the prediction of a correct GS (p < 0.0001; AUC = 0.851; 95% CI from 0.773 to 0.911; Youden index J = 0.6842; Sensitivity 68,42%; Specificity 100%; Figure 1b and Supplementary Table S1)
Summary
Prostate cancer (PCa) is the second most frequent malignancy (after lung cancer) in men and the fifth leading cause of death worldwide [1]. Histological examination of bioptic specimen provides tumor data of the Gleason score (GS), a grading system based on glandular architecture of prostate adenocarcinoma that defines five histological grades with decreasing differentiation. In 2014, the ISUP (International Society of Urological Pathology) and the WHO (World Health Organization) adopted a new grading system composed of five prognostic grade groups, as follows: Gleason score ≤ 6 (prognostic grade group 1), Gleason score 3 + 4 = 7 (prognostic grade group 2), Gleason score 4 + 3 = 7 (prognostic grade group 3), Gleason score 4 + 4 = 8 (prognostic grade group 4) and Gleason score 9–10 (prognostic grade group 5) [4] This simple grading system was originally proposed in 2013 by Pierorazio et al [5] and proved to accurately stratify patients to predict clinical outcomes. It was validated on a larger cohort from five institutions from the Unites States and Europe, demonstrating a distinct biochemical recurrence-free survival between the grade groups [6]
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