Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer

Abstract

Purpose: Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. Materials and Methods: A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. Results: In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. −0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 – 6.28]; p=0.024). Conclusions: US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.

MRI-Fusion Targeted vs. Systematic Prostate Biopsy–How Does the Biopsy Technique Affect Gleason Grade Concordance and Upgrading After Radical Prostatectomy?

“…In contrast to our findings, some authors found the use of TB to be associated with lower rates of Gleason upgrading and higher concordance (13, 14, 24, 25). The largest available study is based on a multicentric cohort published in 2019 by Diamand et al comparing the concordance rates of TB, SB, and a combination of TB and SB in 443 men undergoing RP (24).…”

“…Interestingly, upgrading rates in patients with biopsy GGG 1 had a trend to be higher for patients of the TB- compared to the SB-group. These results corroborate a study by Kayano et al (14). At final pathology, patients with a GGG 1 in the TB-group were upgraded in 75% compared to 65.4% of the SB-group, which is almost identical with the upgrading rates from our series (75 vs. 68.5%) in this subgroup.…”

“…Many debates on the benefit of TB often broach the issue how these findings affect the definite pathology in specimen after radical prostatectomy (RP) (13, 14). However, the effect on Gleason concordance and up-/downgrading rates between biopsy and specimen are currently a matter of debate.…”

The role of multiparametric resonance and biopsy in prostate cancer detection: comparison with definitive histological report after laparoscopic/robotic radical prostatectomy

“…Despite fusion targeted biopsy is able to detect PCa with higher GS and/or upgrade cancers previously detected compared to standard biopsy [24], a small fraction of patients with clinically significant PCa are still missed by target biopsy, due to the failure in the identification of lesion at mpMRI, technical limitations and intralesional GS heterogenicity [25,26]. However, the aid of mpMRI before biopsy could further enhance the detection rate also for systematic biopsy, as shown by the PRECISION trial [27] and reduce the risk of upgrading GS on radical prostatectomy [28][29][30]. Due to these findings, we utilized in our study a biopsy protocol that comprehended a combined approach of systematic and fusion targeted biopsy, in order to obtain the highest possible accuracy.…”

Re: Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer

“…We have read the paper, “Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer” with great interest and appreciate the work of the authors (1). They have compared the Gleason upgrading (GU) rates and tried to determine the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for prostate cancer (PCa).…”