US lesion visibility predicts clinically significant upgrade of prostate cancer by systematic biopsy

Katsuto Shinohara,Jeffry P. Simko,Nathan Velarde,Peder E. Larson,Hao G. Nguyen,Kirti Magudia,Antonio C. Westphalen,John Neuhaus

doi:10.1007/s00261-021-03389-x

Abstract

PurposeTo identify predictors of when systematic biopsy leads to a higher overall prostate cancer grade compared to targeted biopsy.Methods and materials918 consecutive patients who underwent prostate MRI followed by MRI/US fusion biopsy and systematic biopsies from January 2015 to November 2019 at a single academic medical center were retrospectively identified. The outcome was upgrade of PCa by systematic biopsy, defined as cases when systematic biopsy led to a Gleason Grade (GG) ≥ 2 and greater than the maximum GG detected by targeted biopsy. Generalized linear regression and conditional logistic regression were used to analyze predictors of upgrade.ResultsAt the gland level, the presence of an US-visible lesion was associated with decreased upgrade (OR 0.64, 95% CI 0.44–0.93, p = 0.02). At the sextant level, upgrade was more likely to occur through the biopsy of sextants with MRI-visible lesions (OR 2.58, 95% CI 1.87–3.63, p < 0.001), US-visible lesions (OR 1.83, 95% CI 1.14–2.93, p = 0.01), and ipsilateral lesions (OR 3.89, 95% CI 2.36–6.42, p < 0.001).ConclusionSystematic biopsy is less valuable in patients with an US-visible lesion, and more likely to detect upgrades in sextants with imaging abnormalities. An approach that takes additional samples from regions with imaging abnormalities may provide analogous information to systematic biopsy.

Highlights

The definitive diagnosis of prostate cancer (PCa) requires biopsy followed by histopathological analysis [1]
1083 consecutive patients who underwent multiparametric prostate MRI followed by MRI/US fusion-guided biopsy and systematic biopsy from January 2016 to March 2019 at UCSF were retrospectively identified by queries of the electronic medical record (EMR) and radiology information systems
Radiology reports were extracted from the radiology information systems and parsed for PSA density, gland volume, and PIRADS scores. 113 patients were excluded due to prior treatment, imaging artifacts, incomplete T2-weighted imaging (T2WI)/ apparent diffusion coefficient (ADC)/ diffusion weighted imaging (DWI) series, and incomplete biopsy data

Summary

Introduction

The definitive diagnosis of prostate cancer (PCa) requires biopsy followed by histopathological analysis [1]. Lesions visible on prostate MRI are more likely to represent clinically significant PCa (cs-PCa, Gleason score ≥ 3 + 4, GG ≥ 2), and the development of MRI/US fusion-guided biopsy (i.e., MRI-targeted biopsy) has enabled clinicians to accurately sample those lesions [5,6,7,8,9,10]. This approach may require fewer biopsies than systematic biopsy, and has been shown to diagnose more cs-PCa and less low-grade prostate cancer [4, 11,12,13,14].

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