Multiparametric-Magnetic Resonance/Ultrasound Fusion Targeted Prostate Biopsy Improves Agreement Between Biopsy and Radical Prostatectomy Gleason Score.

AIM

To investigate if targeted prostate biopsy (TBx) has superior performance to standard untargeted biopsy (SBx) in determining the optimal agreement between biopsy and surgical Gleason Score (GS).

PATIENTS AND METHODS

An analysis of our institutional longitudinal database identified 683 consecutive patients who underwent either SBx (18-20 standardized transrectal ultrasound peripheral/transitional zone cores) or TBx alone (4-6 cores for each multiparametric magnetic resonance suspicious lesion, Prostate Imaging Reporting and Data System [(PI-RADS)≥3] after a previous negative first SBx. A total of 246 consecutive patients with diagnosis of prostate cancer (117 SBx and 129 TBx diagnoses) who underwent robot-assisted radical prostatectomy between January 2014 and December 2015, were enrolled. The concordance of biopsy GS to pathological GS, as well as the association between categorical variables [age, digital rectal exam (DRE), TNM, PI-RADS], were analyzed by Fisher's exact test.

RESULTS

Prostate cancer was diagnosed in 32.0% of the SBx group and in 49.3% of TBx. The rate of correctly classified, up-graded and down-graded GS was 53.8% vs. 91.5%, 39.3% vs. 7.8% and 6.8% vs. 0.8% for SBx and TBx, respectively (p<0.001). The GS concordance rates for SBx and TBx cohorts were: 14.3% vs. 41.7% for GS 6, 61.0% vs. 83.8% for GS 3+4, 56.3% vs. 75.0% for GS 4+3, 27.3% vs. 100% for GS 8 and 80% vs. 100% for GS 9, respectively.

CONCLUSION

TBx ensured a higher of accuracy of prostate cancer detection and a better performance in discriminating significant from insignificant prostate cancer, when compared to SBx. TBx significantly reduced the risk of GS up-/down-grading at radical prostatectomy for all histopathological categories. This is a notable advance in the selection of candidates for active surveillance.