MP62-09 MRI FUSION BIOPSY IS NOT PROTECTIVE AGAINST UPGRADING PATIENTS ON ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (MP62)1 Sep 2021MP62-09 MRI FUSION BIOPSY IS NOT PROTECTIVE AGAINST UPGRADING PATIENTS ON ACTIVE SURVEILLANCE Robert Parker, Samuel L Washington, Janet E Cowan, Katsuto Shinohara, Hao G Nguyen, and Peter R Carroll Robert ParkerRobert Parker More articles by this author , Samuel L WashingtonSamuel L Washington More articles by this author , Janet E CowanJanet E Cowan More articles by this author , Katsuto ShinoharaKatsuto Shinohara More articles by this author , Hao G NguyenHao G Nguyen More articles by this author , and Peter R CarrollPeter R Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002102.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Systematic transrectal ultrasound-guided prostate biopsy alone may risk under-detection of clinically significant prostate cancers and lead to Gleason grade group (GG) misclassification on active surveillance (AS). This study investigates the effect of MRI-fusion targeting at diagnostic biopsy on the risk of upgrade in a contemporary AS cohort of GG1 patients. METHODS: Participants were included if they had enrolled in AS between 2015-2018 with GG1 diagnosed on 10+ core systematic biopsy with or without additional MR fusion, PSA <20, cT1/2, and CAPRA risk 0-5, followed by confirmatory biopsy within 18 months. Upgrade was defined as an increase in GG on confirmatory or surveillance biopsy. Logistic and Cox proportional hazards regression models examined association between fusion biopsy and risk of upgrade at confirmatory biopsy and surveillance biopsy, respectively. Models were adjusted for age, PSA, prostate volume, percent positive cores, and genomic testing. RESULTS: Among 166 men with mean age of 63 ± 7 years and median PSA of 5.6 (IQR 4.4-7.7) at diagnosis, fusion biopsy was performed on 63 men (38%). Additional TRUS targeting was performed on 32 men (19%). A median of 14 diagnostic biopsy cores (IQR 12-18) were taken on systematic biopsy. Sixty men (36%) upgraded on confirmatory biopsy and 10 men (6%) subsequently upgraded during follow-up (median 48 months [IQR 38-59]). Twenty-five men (15%) had no cancer detected on confirmatory biopsy. On Cox proportional hazards regression, older age was associated with increased risk of upgrade after diagnosis (HR 1.05; 95% CI 1.00-1.09). On logistic and Cox proportional hazards regressions, fusion biopsy was not associated with decreased risk of upgrade at confirmatory or surveillance biopsy. CONCLUSIONS: In a contemporary AS cohort of GG1 patients, initial fusion biopsy was not protective against upgrade at confirmatory or surveillance biopsy. MR fusion targeting may add limited accuracy to consistently performed, templated biopsy procedures, particularly when there is additional TRUS-directed sampling. Source of Funding: UCSF Goldberg-Benioff Program in Cancer Translational Biology © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1095-e1095 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Parker More articles by this author Samuel L Washington More articles by this author Janet E Cowan More articles by this author Katsuto Shinohara More articles by this author Hao G Nguyen More articles by this author Peter R Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...