Central prostate biopsy revision at referral center is key for correct patient management: Results from a prospective, single center series

Bianchi, M.; Bravi, Carlo Andrea; Fossati, Nicola; Gandaglia, G.; Dell’Oglio, Paolo; Bandini, Marco; Zaffuto, E.; Karakiewicz, P.; Capitanio, Umberto; Shariat, S.F.; Scattoni, Vincenzo; Bertini, Roberto; Montironi, Rodolfo; Freschi, Massimo; Doglioni, Claudio; Montorsi, F.; Briganti, Alberto

doi:10.1016/s1569-9056(18)33368-2

European Urology Supplements

2018

DOI: 10.1016/s1569-9056(18)33368-2

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Central prostate biopsy revision at referral center is key for correct patient management: Results from a prospective, single center series

M. Bianchi¹,

Carlo Andrea Bravi²,

Nicola Fossati³

et al.

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“…2 At our institution, the rate of patients potentially eligible for AS managed with radical prostatectomy significantly decreased from 13% to 2% based on original biopsy and after revision by dedicated uropathologists, respectively. 3 Likewise, up to 46% of PI-RADSÔ scores are changed after a thorough revision of magnetic resonance imaging done by experienced, dedicated uroradiologists at our tertiary referral center. We are afraid that this is a very common issue everywhere, but that being said, this is almost never faced in the contemporary scientific literature.…”

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confidence: 99%

Defining Quality Metrics for Active Surveillance: The Michigan Urological Surgery Improvement Collaborative Experience. Letter.

et al. 2021

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mentioning

confidence: 99%

Defining Quality Metrics for Active Surveillance: The Michigan Urological Surgery Improvement Collaborative Experience. Letter.

et al. 2021

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“…2 At our institution, the rate of patients potentially eligible for AS managed with radical prostatectomy significantly decreased from 13% to 2% based on original biopsy and after revision by dedicated uropathologists, respectively. 3 Likewise, up to 46% of PI-RADS™ scores are changed after a thorough revision of magnetic resonance imaging done by experienced, dedicated uroradiologists at our tertiary referral center. We are afraid that this is a very common issue everywhere, but that being said, this is almost never faced in the contemporary scientific literature.…”

mentioning

confidence: 99%

The Long-Term Risks of Metastases in Men on Active Surveillance for Early Stage Prostate Cancer. Letter.

2021

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To illustrate these subtle differences in the 2 sets of quality metrics, consider a hypothetical 60-year-old gentleman with newly diagnosed Gleason grade group 1 prostate cancer. He has MRI 4 months after diagnosis that demonstrates a PI-RADSÒ 2 lesion. He has his PSA checked at 6, 12, and 18 months after diagnosis which shows his PSA is stable. According to the MUSIC criteria, his management up to this point fulfills the metrics for high-quality care but according to the PCASP criteria, this care is suboptimal because he did not have a biopsy during this interval. Given the deficiencies in the current state of active surveillance literature, how a urologist performs active surveillance is mostly gestalt and not a data driven process. The paucity of evidence makes it difficult to judge which set of metrics is "right" with regard to the management of this hypothetical patient or more broadly the appropriate interval of PSA testing, confirmatory/surveillance biopsies, and integration of newer biomarkers such as MRI and genomics into the performance of active surveillance.Although the ideal active surveillance regimen or protocol remains unknown, what has been definitively proven is that active surveillance is safe and should be the default initial management strategy for most men with low risk and favorable risk prostate cancer. It is unlikely that one of these proposed quality metric schemes will prove superior to the other in terms of preventing metastasis or death from prostate cancer. Given the lack of a universal active surveillance protocol, it will be prudent for urologists, and groups such as MUSIC, PCASP, and the American Urological Association, to remain engaged in this discussion in order to advocate for metrics which they believe translate to providing highest quality care to their patients.

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Re: Ola Bratt, Erik Holmberg, Ove Andrén, et al. The Value of an Extensive Transrectal Repeat Biopsy with Anterior Sampling in Men on Active Surveillance for Low-risk Prostate Cancer: A Comparison from the Randomised Study of Active Monitoring in Sweden (SAMS). Eur Urol 2019;76:461–6

et al. 2020

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Central prostate biopsy revision at referral center is key for correct patient management: Results from a prospective, single center series

Cited by 3 publications

References 0 publications

Defining Quality Metrics for Active Surveillance: The Michigan Urological Surgery Improvement Collaborative Experience. Letter.

Defining Quality Metrics for Active Surveillance: The Michigan Urological Surgery Improvement Collaborative Experience. Letter.

The Long-Term Risks of Metastases in Men on Active Surveillance for Early Stage Prostate Cancer. Letter.

Re: Ola Bratt, Erik Holmberg, Ove Andrén, et al. The Value of an Extensive Transrectal Repeat Biopsy with Anterior Sampling in Men on Active Surveillance for Low-risk Prostate Cancer: A Comparison from the Randomised Study of Active Monitoring in Sweden (SAMS). Eur Urol 2019;76:461–6

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