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

Abstract

Introduction: MRI-targeted biopsy (TB) increases overall prostate-cancer (PCa) detection-rates and decreases the risk of insignificant PCa detection. However, the impact of these findings on the definite pathology after radical prostatectomy (RP) is under debate.Materials and Methods: Between 01/2014 and 12/2018, 366 patients undergoing prostate biopsy and RP were retrospectively analyzed. The correlation between biopsy Gleason-score (highest Gleason-score in a core) and the RP Gleason-score in patients undergoing systematic biopsy (SB-group) (n = 221) or TB+SB (TB-group, n = 145) was tested using the ISUP Gleason-group grading (GGG, scale 1–5). Sub analyses focused on biopsy GGG 1 and GGG ≥ 2.Results: Proportions of biopsy GGG 1–5 in the SB-group and TB-group were 24.4, 37.6, 19, 10.9, 8.1% and 13.8, 43.4, 24.2, 13.8, 4.8%, respectively (p = 0.07). Biopsy and pathologic GGG were concordant in 108 of 221 (48.9%) in SB- and 74 of 145 (51.1%) in TB-group (p = 0.8). Gleason upgrading was recorded in 33.5 and 31.7% in SB- vs. TB-group (p = 0.8). Patients with biopsy GGG 1 undergoing RP showed an upgrading in 68.5%(37/54) in SB- and 75%(15/20) in TB-group (p = 0.8). In patients with biopsy GGG ≥ 2 concordance increased for both biopsy approaches (54.5 vs. 55.2% for SB- vs. TB-group, p = 0.9).Discussion: Irrespective of differences in PCa detection-rates between TB- and SB-groups, no significant differences in GGG concordance and upgrading between patients of both groups undergoing biopsy, followed by RP, were recorded. Concordance rates increased in men with biopsy GGG ≥ 2. TB seems to detect more patients with PCa without a difference in concordance with final pathology.

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

“…These observations do not completely agree with previous publications, where SB and TB were not compared within the same patient. For example, Rührup et al and Apfelbeck et al reported a concordance of between 46.7%–48.9% with SB alone [ 8 , 11 ]. Conversely, the upgrading rate in the study by Apfelbeck et al was invariably higher (46.7%).…”

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

“…MRI‐targeted biopsies, which utilise previously taken MRI images of suspected cancer and fuse them with real‐time ultrasound images, are reported to be able to detect high‐grade cancers better than systematic biopsies and TRUS 6‐9,20,21 . However, several recent studies have reported a mismatch in the biopsy and radical prostatectomy Gleason Score 10,11,22 . Despite the improved detection of clinically significant cancers with MRI‐targeted biopsies, considerable disparity exists in the literature regarding MRI‐targeted biopsy's ability to better detect RP pathology in biopsy‐naive men over conventional TRUS biopsies 10,11,22 .…”

“…[6][7][8][9]20,21 However, several recent studies have reported a mismatch in the biopsy and radical prostatectomy Gleason Score. 10,11,22 Despite the improved detection of clinically significant cancers with MRI-targeted biopsies, considerable disparity exists in the literature regarding MRI-targeted biopsy's ability to better detect RP pathology in biopsy-naive men over conventional TRUS biopsies. 10,11,22 We performed this study in order to investigate if targeted prostate biopsy has a performance superior to untargeted biopsy in determining the optimal agreement between biopsy and surgical Gleason Score.…”

“…Prior researches have shown that multiparametric MRI‐targeted biopsy identifies clinically significant prostate cancers more accurately than conventional systematic biopsy in men with suspected localised prostate cancer 6‐9 . Despite the improved detection of clinically significant cancers with MRI‐targeted biopsies, debate persists about whether MRI‐targeted biopsy better predicts final pathology at radical prostatectomy 10,11 . The MRI‐targeted biopsy results in the previous studies reported that targeted biopsies have a higher rate of concordance level with the RP compared to systematic biopsy 6‐8,12‐14 .…”

“…[6][7][8][9] Despite the improved detection of clinically significant cancers with MRI-targeted biopsies, debate persists about whether MRI-targeted biopsy better predicts final pathology at radical prostatectomy. 10,11 The MRI-targeted biopsy results in the previous studies reported that targeted biopsies have a higher rate of concordance level with the RP compared to systematic biopsy. [6][7][8][12][13][14] However, there is limited data comparing to head to head concordance, upgrading and downgrading between conventional TRUS-Bx and MRI Fusion biopsies according to ISUP grade groups.…”