Presentation Authors: Grant M Henning*, Joel M Vetter, Gerald L Andriole, Jonathan R Weese, Eric H Kim, St. Louis, MO
Introduction: Multiparametric magnetic resonance imaging (mpMRI) with and without targeted biopsy has been suggested to improve risk assessment over systematic standard biopsy for prostate cancer (PCa). We aim to compare histologic upgrading between prostate biopsy and radical prostatectomy (RP) in men with and without prostate mpMRI prior to biopsy.
Methods: We examined our PCa database from October 2014 to June 2017 and identified 363 men who underwent RP within one year of diagnostic biopsy. Men with 3-Tesla mpMRI prior to biopsy were compared to men who had not had prior MRI (mpMRI 155, no MRI 208). All mpMRI were reported using the Prostate Imaging Reporting and Data System (PIRADS). All men received a systematic standard template prostate biopsy, and men with prior mpMRI and PIRADS classification 3 to 5 lesions underwent additional MRI targeted biopsy using the UroNav platform. For our analysis, we compared the highest Gleason grade group (GGG) at biopsy and at RP pathologic analysis. Men were sub-stratified based on NCCN criteria using biopsy GGG and PSA into low-risk, intermediate-favorable-risk, intermediate-unfavorable-risk, high-risk, and very-high-risk categories. Men with prior mpMRI were also sub-stratified based on highest PIRADS classification.
Results: Overall, there was no difference between the prior mpMRI and no MRI cohorts in pre-biopsy PSA (9.0 vs 8.7, p=0.96), biopsy GGG (p=0.40), and RP GGG (p=0.81). Men with prior mpMRI were older (65.3 vs 62.1, p < 0.01) and less likely to be biopsy naive (52.3% vs 74.5%, p < 0.01). We found no significant differences in histologic upgrading (29.7% vs 27.4%, p=0.64) between the prior mpMRI and no MRI cohorts. No differences in histologic upgrading were found when men were stratified into risk groups based on NCCN criteria (Figure 1). Further examination of the prior mpMRI cohort revealed that increasing PIRADS classification did not correlate with histologic upgrading rate (Figure 1).
Conclusions: Although prostate mpMRI is a useful tool in the diagnosis and management of PCa, we found histologic upgrading between biopsy and RP was not significantly impacted by prostate mpMRI. For men planning to undergo prostatectomy after standard biopsy, preoperative prostate mpMRI with subsequent targeted biopsy does not provide a diagnostic benefit.