Comparison of TRUS and combined MRI‐targeted plus systematic prostate biopsy for the concordance between biopsy and radical prostatectomy pathology

Abstract

Aim To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing conventional 12‐core TRUS‐Bx at radical prostatectomy specimens (RP). Methods Consecutive patients diagnosed prostate cancer (127 with combination of both targeted biopsy (TBx) plus systematic biopsies (SBx) and separate patient cohort of 330 conventional TRUS‐Bx without mpMRI) with a PSA level of <20 ng/mL prior to RP were included. The primary end point was the grade group concordance between biopsy and RP pathology according to biopsy technique. Results Clinically significant prostate cancer detection was 51.2% for TRUS‐Bx, 49.5% for SBx, 67% for TBx and 75.7% for TBx + SBx. Upgrading and downgrading of at least one Gleason Grade Group (GGG) was recorded in 43.3%/ 6.7% patients of the TRUS‐Bx and in 20.5%/ 22% of the TBX + SBx group, respectively (all P < .001). Concordance level was detected to be significantly higher for ISUP 1 in combined TBx + SBx method compared to conventional TRUS‐Bx (61.3% vs 37.9%, P = .014). In ISUP 1 exclusively, significant upgrading was seen in TRUS‐Bx (62.1%) when compared to TBx (41.4%) and TBx + SBx (38.7%). Conclusions MRI‐targeted biopsies detected more significant PCa than TRUS‐Bx but, superiority in significant cancer detection appears as a result of inadvertant selective sampling of small higher grade areas. Within an otherwise low grade cancer and does not reflect accurate GGG final surgical pathology. TBx + SBx has the greatest concordance in ISUP Grade 1 with less upgrading which is utmost important for active surveillance.

Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy

“…Within recent years, multiparametric magnetic-resonance imaging (MRI)-target prostate biopsy (TB) of suspicious lesions in MRI, in addition to a systematic 12-core biopsy (SB), has become frequently employed [7]. Multiple studies and meta-analyses investigated a higher concordance of biopsy GS in the combined effect of TB + SB compared to SB alone regarding final pathological GS [8][9][10][11][12][13][14]. However, in these studies an undeniable proportion of patients are affected by up-or downgrading after pathological results.…”

Application of targeted diagnosis of PSMA in the modality shift of prostate cancer diagnosis: a review

“…Secondly, studies have shown that hybrid PET/CT and PET/MRI targeting PSMA are more accurate in the diagnosis of metastatic and recurrent PCa ( 85 – 87 ). In addition, invasive biopsy of PCa has a significant false negative rate ( 88 ), and studies have shown that guided biopsy of PCa by PSMA PET/CT can significantly improve the DR ( 59 , 76 ). Therefore, PSMA PET/CT is of great value in the diagnosis of PCa.…”

Molecular Imaging in Primary Staging of Prostate Cancer Patients: Current Aspects and Future Trends

“…Additionally, the novel field of radiomics has recently been exploited in PCa [ 215 ] and is expected to increase the accuracy of interpretation and prediction of the stage and outcome. Noteworthy, invasive biopsy has a significant false-negative rate [ 82 ], which can be reduced by the guidance of imaging. The role of PET/CT, PET/MRI and radiomics needs to be clarified for the guided biopsy of the prostate gland.…”

“…Uprimny et al reported patient-based sensitivity of 91% compared to the TRUS-guided biopsy [ 81 ]. However, it is known that TRUS-guided biopsy per se is suboptimal for the detection of primary PCa [ 82 ]. Several other publications addressed this issue, and ultimately in a meta-analysis, von Eyben et al reported the pooled lesion-based sensitivity and specificity of 70% (95% CI: 53–83%) and 84% (95% CI: 24–99%) for the detection of primary tumor, respectively [ 83 ].…”