Presentation Authors: Giorgio Gandaglia*, Milan, Italy, Guillaume Ploussard, Toulouse, France, Massimo Valerio, Lausanne, Switzerland, Agostino Mattei, Lucerne, Switzerland, Cristian Fiori, Orbassano (Turin), Italy, Nicola Fossati, Armando Stabile, Milan, Italy, Jean-Baptiste Beauval, Bernard Malavaud, Mathieu Roumiguié, Toulouse, France, Daniele Robesti, Paolo Dell'Oglio, Federico Dehò, Umberto Capitanio, Milan, Italy, Marco Moschini, Stefania Zamboni, Lucerne, Switzerland, Arnas Rakauskas, Lausanne, Switzerland, Francesco De Cobelli, Milan, Italy, Francesco Porpiglia, Orbassano (Turin), Italy, Francesco Montorsi, Alberto Briganti, Milan, Italy
Introduction: Adding systematic cores to MRI-targeted biopsy might improve the detection of clinically significant Prostate Cancer (PCa). Nonetheless, the implications of adding systematic cores in predicting adverse pathology in men undergoing radical prostatectomy (RP) are still unknown.
Methods: Overall, 659 patients who underwent MRI-targeted biopsy and RP between 2016 and 2018 at five referral centers were identified. All patients received concomitant systematic biopsy at the time of targeted biopsy. The D&[prime]Amico risk groups and the rate of pathological upgrading were assessed considering grade group at targeted biopsy and after adding information from systematic biopsy. A logistic regression model assessed the impact of MRI-targeted biopsy parameters (PSA, prostate volume, grade group at target biopsy, clinical stage and the diameter of the mpMRI lesion) on the risk of upgrading. A model that included also information on clinically significant PCa outside the index lesion, the number of random positive and total cores was developed. Their discrimination was compared using the area under the curve (AUC).
Results: Median PSA was 7.8ng/ml. Targeted biopsy grade group was 1, 2, 3, and â‰¥4 in 86 (13%), 325 (49.3%), 138 (20.9%) and 110 (17%) patients. When considering also systematic cores, biopsy grade group was 1, 2, 3, and â‰¥4 in 60 (9%), 333 (50%), 145 (22%) and 121 (18%) men. Overall, 86 (13.1%), 445 (67%) and 128 (19%) patients had low-, intermediate- and high-risk disease at targeted biopsy. When considering information from systematic biopsy, 42 (6.4%), 451 (68%) and 166 (25%) patients had low-, intermediate- and high-risk. While 40 (46%) low-risk patients were reclassified as intermediate-risk, 5 (5.8%) and 33 (7.4%) low- and intermediate-risk patients were reclassified as high-risk. Upgrading decreased from 32% for targeted biopsies to 28% when including information from systematic biopsy (P=0.04). Significant disease at systematic biopsy and a higher number of systematic cores taken were associated with a reduced risk of upgrading (all Pâ‰¤0.01). The discrimination of a model predicting upgrading including systematic biopsy information was higher compared to including targeted biopsy only (AUC: 78 vs. 72%).
Conclusions: Adding systematic biopsy to targeted cores reduces the risk of upgrading. Our data reinforce the need for accurate systematic biopsy sampling to improve accuracy for tumor grading and to optimize patient selection for active surveillance or focal therapies.