Correction to: Overdiagnosis and stage migration of ISUP 2 disease due to mpMRI-targeted biopsy: facts or fictions

Martini, Alberto; Touzani, Alae; Mazzone, Elio; Roumiguié, M.; Marra, Giancarlo; Valério, Massimo; Beauval, Jean Baptiste; Campi, Riccardo; Minervini, Andrea; Soeterik, Timo; Zhuang, Junlong; H, Guo; Montorsi, Francesco; Briganti, Alberto; Gandaglia, Giorgio; Ploussard, Guillame; Berg, Roderick C. N. van den

doi:10.1038/s41391-022-00637-z

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“…Our results support the findings of two previous studies comparing the pathological concordance of systematic and targeted biopsies to radical prostatectomy[20, 21]. Downgrading to GG1 after radical prostatectomy was uncommon regardless of the biopsy method while upgrading was significantly more common in men with GG1 on systematic biopsy.…”

Section: Discussionsupporting

confidence: 90%

MRI-Targeted Prostate Biopsy Introduces Grade Inflation and Overtreatment

Batouche,

Czeizler,

Lehto

et al. 2024

Preprint

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Purpose: The use of MRI-targeted biopsies has led to lower detection of Gleason Grade Group 1 (GG1) prostate cancer and increased detection of GG2 disease. Although this finding is generally attributed to improved sensitivity and specificity of MRI for aggressive cancers, it might also be explained by grade inflation. Our objective was to determine the likelihood of definitive treatment and risk of post-treatment recurrence for patients with GG2 cancer diagnosed using targeted biopsies relative to men with GG1 cancer diagnosed using systematic biopsies. Materials and Methods: We performed a retrospective study on a large tertiary center registry (HUS Acamedic Datalake) to retrieve data on prostate cancer diagnosis, treatment, and cancer recurrence. We included patients with either GG1 with systematic biopsies (3317 men) or GG2 with targeted biopsies (554 men) from 1993 to 2019. We assessed the risk of curative treatment and recurrence after treatment. Kaplan-Meier survival curves were computed to assess treatment- and recurrence-free survival. Cox proportional hazards regression analysis was performed to assess the risk of posttreatment recurrence. Results: Patients with systematic biopsy detected GG1 cancer had a significantly longer median time-to-treatment (31 months) than those with targeted biopsy detected GG2 cancer (4 months, p<0.0001). Risk of recurrence after curative treatment was similar between groups with the upper bound of the 95% CI, excluding an important difference (HR: 0.94, 95% CI [0.71-1.25], p=0.7). Conclusions: GG2 cancers detected by MRI-targeted biopsy are treated more aggressively than GG1 cancers detected by systematic biopsy, despite having similar oncologic risk. To prevent further overtreatment related to the MRI pathway, treatment guidelines from the pre-MRI era need to be updated to consider changes in the diagnostic pathway.

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Section: Discussionsupporting

confidence: 90%