MP46-14 LOOKING BEYOND CANCER DETECTION: IS TEMPLATE BIOPSY BETTER THAN TRUS BIOPSY IN PLANNING NERVE SPARING ROBOTIC RADICAL PROSTATECTOMY IN THE MULTIPARAMETRIC MRI ERA?

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2018MP46-14 LOOKING BEYOND CANCER DETECTION: IS TEMPLATE BIOPSY BETTER THAN TRUS BIOPSY IN PLANNING NERVE SPARING ROBOTIC RADICAL PROSTATECTOMY IN THE MULTIPARAMETRIC MRI ERA? Dimitrios Moschonas, Edward Bass, Pavlos Pavlakis, Murthy Kusuma, Stylianos Chintzoglou, Krishnaji Patil, Christopher Eden, Matthew Perry, and Stephen Langley Dimitrios MoschonasDimitrios Moschonas More articles by this author , Edward BassEdward Bass More articles by this author , Pavlos PavlakisPavlos Pavlakis More articles by this author , Murthy KusumaMurthy Kusuma More articles by this author , Stylianos ChintzoglouStylianos Chintzoglou More articles by this author , Krishnaji PatilKrishnaji Patil More articles by this author , Christopher EdenChristopher Eden More articles by this author , Matthew PerryMatthew Perry More articles by this author , and Stephen LangleyStephen Langley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1473AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical decision-making at radical prostatectomy is of vital importance to maximizing biochemical disease-free survival as well as quality of life. Accurate characterisation of a patient′s tumour at diagnosis is thus paramount. Whilst the bulk of existing data has focused on cancer detection, little has been done in regard to whether biopsy strategies have demonstrable effect on surgical outcome. Our aim was to assess the impact of biopsy method on nerve sparing robotic assisted radical prostatectomy (RARP) and positive surgical margin (PSM) rates. METHODS We analysed our prospectively collected data of consecutive patients who underwent primary RARP following a diagnosis of CaP at a single referral centre between October 2010 and June 2017. All patients underwent multiparametric MRI (mpMRI) and either transrectal ultrasound guided (TRUS) or template transperineal biopsy. Data included presenting PSA (pPSA); patient age; clinical and radiological T stage; biopsy type and Gleason grade; D′Amico risk classification; whole-mount Gleason grade, prostate and tumour volumes; PSM status, site and length. PSM status was compared between groups. RESULTS 771 patients were included in the study, with 343 (44.5%) having undergone TRUS and 428 (55.6%) template biopsies. Median age was 66 [IQR 60-69] and median pPSA 7.2 [IQR 5.3-10.7]. Nerve sparing procedures were performed in 273 (79.6%) men following mpMRI and TRUS and 330 (77.1%) following mpMRI and template. PSM rates were significantly higher in the mpMRI and TRUS groups than in the mpMRI and template groups (p=0.005). Subgroup analysis demonstrated advantage of mpMRI and template in D′Amico high (p=0.04) and intermediate (p=0.04) risk groups. CONCLUSIONS MpMRI and template biopsy are superior to the combination of mpMRI and TRUS in surgical planning leading to better pathologic margin outcomes for patients. Targeted biopsy strategies beyond cancer detection, confidently support clinical decision making of nerve sparing prostatectomy approach © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e611-e612 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dimitrios Moschonas More articles by this author Edward Bass More articles by this author Pavlos Pavlakis More articles by this author Murthy Kusuma More articles by this author Stylianos Chintzoglou More articles by this author Krishnaji Patil More articles by this author Christopher Eden More articles by this author Matthew Perry More articles by this author Stephen Langley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...