PD39-05 IMPACT OF MRI-TARGETING ON PATHOLOGIC UPGRADING AND DOWNGRADING AT PROSTATECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

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You have accessJournal of UrologyCME1 Apr 2023PD39-05 IMPACT OF MRI-TARGETING ON PATHOLOGIC UPGRADING AND DOWNGRADING AT PROSTATECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS Ilon Weinstein, Xian Wu, Alexander Hill, Donald Brennan, Danly Omil-Lima, Spyridon Basourakos, Aaron Brant, Patrick Lewicki, Bashir Al Hussein Al Awamlh, Daniel Spratt, Leonardo Kayat Bittencourt, Doug Scherr, Nicholas Zaorsky, Himanshu Nagar, Jim Hu, Christopher Barbieri, Lee Ponsky, Andrew Vickers, and Jonathan Shoag Ilon WeinsteinIlon Weinstein More articles by this author , Xian WuXian Wu More articles by this author , Alexander HillAlexander Hill More articles by this author , Donald BrennanDonald Brennan More articles by this author , Danly Omil-LimaDanly Omil-Lima More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Aaron BrantAaron Brant More articles by this author , Patrick LewickiPatrick Lewicki More articles by this author , Bashir Al Hussein Al AwamlhBashir Al Hussein Al Awamlh More articles by this author , Daniel SprattDaniel Spratt More articles by this author , Leonardo Kayat BittencourtLeonardo Kayat Bittencourt More articles by this author , Doug ScherrDoug Scherr More articles by this author , Nicholas ZaorskyNicholas Zaorsky More articles by this author , Himanshu NagarHimanshu Nagar More articles by this author , Jim HuJim Hu More articles by this author , Christopher BarbieriChristopher Barbieri More articles by this author , Lee PonskyLee Ponsky More articles by this author , Andrew VickersAndrew Vickers More articles by this author , and Jonathan ShoagJonathan Shoag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003342.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The evidence supporting multiparametric magnetic resonance imaging (mpMRI) targeting for biopsy is nearly exclusively based on biopsy pathologic outcomes. This is problematic, as targeting likely allows the preferential identification of small high-grade areas of questionable oncologic significance, raising the likelihood of overdiagnosis and overtreatment. We estimate the impact of MRI-targeted, systematic, and combined biopsies on radical prostatectomy (RP) grade group concordance. METHODS: PubMed MEDLINE and Cochrane Library were searched from July 2018 - January 2022. Studies that conducted systematic and MRI-targeted prostate biopsies and compared biopsy results with pathology after RP were included. We performed a meta-analysis to assess whether pathologic upgrading and downgrading was influenced by biopsy type and a net-benefit analysis using pooled risk-difference (RD) estimates. RESULTS: Both targeted and combined biopsies were less likely to result in upgrading (odds ratio [OR] vs. systematic of 0.70 (95% CI 0.63-0.77, p<0.001 and 0.50, 95% CI 0.45-0.55, p<0.001), respectively). Combined biopsy doubled the odds of downgrading (1.96, 95% CI, 1.68- 2.27, p<0.001) compared to systematic biopsies (15% vs. 9.0%). Net benefit of targeted and combined biopsies is 8 and 7 per 100 if harms of up- and downgrading are considered equal, but 7 and -1 per 100 if the harm of downgrading is considered twice that of upgrading. CONCLUSIONS: Combined MRI- and systematic biopsies are associated with less upgrading but more downgrading at RP. Our findings highlight a potential net-harm of performing combined MRI-targeted and systematic biopsies if pathologic downgrading is considered more detrimental than upgrading at prostatectomy. Strong heterogeneity suggests further research into factors that influence rates of up- and downgrading and should distinguish clinically relevant from irrelevant grade changes. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1046 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ilon Weinstein More articles by this author Xian Wu More articles by this author Alexander Hill More articles by this author Donald Brennan More articles by this author Danly Omil-Lima More articles by this author Spyridon Basourakos More articles by this author Aaron Brant More articles by this author Patrick Lewicki More articles by this author Bashir Al Hussein Al Awamlh More articles by this author Daniel Spratt More articles by this author Leonardo Kayat Bittencourt More articles by this author Doug Scherr More articles by this author Nicholas Zaorsky More articles by this author Himanshu Nagar More articles by this author Jim Hu More articles by this author Christopher Barbieri More articles by this author Lee Ponsky More articles by this author Andrew Vickers More articles by this author Jonathan Shoag More articles by this author Expand All Advertisement PDF downloadLoading ...