MRI-Fusion Targeted vs. Systematic Prostate Biopsy-How Does the Biopsy Technique Affect Gleason Grade Concordance and Upgrading After Radical Prostatectomy?

Jessica Rührup,Jens Köllermann,Lena Theißen,Mike Wenzel,Luis A Kluth,Frederik C Roos,Philipp Mandel,Felix K H Chun,Andreas Becker,Boris Bodelle,Felix Preisser

doi:10.3389/fsurg.2019.00055

Jessica Rührup, Jens Köllermann + Show 9 more

Open Access

https://doi.org/10.3389/fsurg.2019.00055

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Abstract

Introduction: MRI-targeted biopsy (TB) increases overall prostate-cancer (PCa) detection-rates and decreases the risk of insignificant PCa detection. However, the impact of these findings on the definite pathology after radical prostatectomy (RP) is under debate.Materials and Methods: Between 01/2014 and 12/2018, 366 patients undergoing prostate biopsy and RP were retrospectively analyzed. The correlation between biopsy Gleason-score (highest Gleason-score in a core) and the RP Gleason-score in patients undergoing systematic biopsy (SB-group) (n = 221) or TB+SB (TB-group, n = 145) was tested using the ISUP Gleason-group grading (GGG, scale 1–5). Sub analyses focused on biopsy GGG 1 and GGG ≥ 2.Results: Proportions of biopsy GGG 1–5 in the SB-group and TB-group were 24.4, 37.6, 19, 10.9, 8.1% and 13.8, 43.4, 24.2, 13.8, 4.8%, respectively (p = 0.07). Biopsy and pathologic GGG were concordant in 108 of 221 (48.9%) in SB- and 74 of 145 (51.1%) in TB-group (p = 0.8). Gleason upgrading was recorded in 33.5 and 31.7% in SB- vs. TB-group (p = 0.8). Patients with biopsy GGG 1 undergoing RP showed an upgrading in 68.5%(37/54) in SB- and 75%(15/20) in TB-group (p = 0.8). In patients with biopsy GGG ≥ 2 concordance increased for both biopsy approaches (54.5 vs. 55.2% for SB- vs. TB-group, p = 0.9).Discussion: Irrespective of differences in PCa detection-rates between TB- and SB-groups, no significant differences in GGG concordance and upgrading between patients of both groups undergoing biopsy, followed by RP, were recorded. Concordance rates increased in men with biopsy GGG ≥ 2. TB seems to detect more patients with PCa without a difference in concordance with final pathology.

Highlights

MRI-targeted biopsy (TB) increases overall prostate-cancer (PCa) detection-rates and decreases the risk of insignificant PCa detection
MpMRI of the prostate is becoming an integrative part in the diagnostic workup of PCa [10, 18, 19]
Several prospective trials demonstrated that TB can increase PCa detection rates, especially the detection rate of clinically significant PCa (GGG ≥ 2), while lowering the detection rate of low-risk-PCa [9, 11, 20]

Summary

Introduction

MRI-targeted biopsy (TB) increases overall prostate-cancer (PCa) detection-rates and decreases the risk of insignificant PCa detection. The use of multiparametric magnetic resonance imaging (mpMRI) and MRI-targeted biopsy (TB) to improve PCa detection is a frequently debated topic [6,7,8,9], especially since current multicentric randomized trials, like the “Prostate evaluation for clinically important disease: sampling using image guidance or not?”–trial (PRECISION) and the “Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer”-trial (PROMIS), showed the superiority of TB—by increasing the overall PCa detection rate and reducing the detection of insignificant tumors (e.g., Gleason 3+3) [10, 11].

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