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; Guo, Hongqian; Gontero, Paolo; Montorsi, Francesco; Briganti, Alberto; Gandaglia, Giorgio; Ploussard, Guillame; Berg, Roderick C. N. van den

doi:10.1038/s41391-022-00606-6

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…First, half of the overall population treated with RARP belonged to the high-risk PCa category. This phenomenon is widely known as “PCa stage migration” and is consistent with previous authors’ results [ 55 , 56 , 57 ]. Indeed, Hoeh et al showed the same phenomenon in 550 PCa patients prospectively collected at the Department of Urology of University Hospital Frankfurt, Germany [ 56 ].…”

Section: Discussionsupporting

confidence: 93%

Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center

et al. 2023

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Background and Objectives: To describe the predictors of cribriform variant status and perineural invasion (PNI) in robot-assisted radical prostatectomy (RARP) histology. To define the rates of upgrading between biopsy specimens and final histology and their possible predictive factors in prostate cancer (PCa) patients undergoing RARP. Material and Methods: Within our institutional database, 265 PCa patients who underwent prostate biopsies and consecutive RARP at our center were enrolled (2018–2022). In the overall population, two independent multivariable logistic regression models (LRMs) predicting the presence of PNI or cribriform variant status at RARP were performed. In low- and intermediate-risk PCa patients according to D’Amico risk classification, three independent multivariable LRMs were fitted to predict upgrading. Results: Of all, 30.9% were low-risk, 18.9% were intermediate-risk and 50.2% were high-risk PCa patients. In the overall population, the rates of the cribriform variant and PNI at RARP were 55.8% and 71.1%, respectively. After multivariable LRMs predicting PNI, total tumor length in biopsy cores (>24 mm [OR: 2.37, p-value = 0.03], relative to <24 mm) was an independent predictor. After multivariable LRMs predicting cribriform variant status, PIRADS (3 [OR:15.37], 4 [OR: 13.57] or 5 [OR: 16.51] relative to PIRADS 2, all p = 0.01) and total tumor length in biopsy cores (>24 mm [OR: 2.47, p = 0.01], relative to <24 mm) were independent predicting factors. In low- and intermediate-risk PCa patients, the rate of upgrading was 74.4% and 78.0%, respectively. After multivariable LRMs predicting upgrading, PIRADS (PIRADS 3 [OR: 7.01], 4 [OR: 16.98] or 5 [OR: 20.96] relative to PIRADS 2, all p = 0.01) was an independent predicting factor. Conclusions: RARP represents a tailored and risk-adapted treatment strategy for PCa patients. The indication of RP progressively migrates to high-risk PCa after a pre-operative assessment. Specifically, the PIRADS score at mpMRI should guide the decision-making process of urologists for PCa patients.

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Section: Discussionsupporting

confidence: 93%

Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center

et al. 2023

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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%

“…The existing literature on targeted biopsy-induced grade inflation is mostly based on data available at diagnosis (pathology at biopsy and radical prostatectomy) and extrapolation into cohorts with virtually no prostate cancer mortality after benign or low-grade prostate cancer on systematic biopsy, even after an extended follow up [8,17]. While our results and empirical evidence support grade inflation, they are also in line with both the expert opinion raised in the literature [18,19] and with the available literature findings [14,[20][21][22]. Vickers 2021 [8] addressed the possibility of overtreatment related to the use of targeted biopsies.…”

Section: Discussionsupporting

confidence: 86%

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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“…All the MRI results were then contoured using the bkFusion software (BK5000, BK Medical, DK 2730 Herlev; Denmark), prior to the biopsy, by an expert radiologist, by outlining the prostate shape and each reported lesion, using different signaling colors. Every patient underwent an FUS-TB, according to the mpMRI results [23,24].…”

Section: Study Populationmentioning

confidence: 99%

Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial

Turchi,

Lombardo,

Franco

et al. 2024

Current Oncology

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The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient’s discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients’ experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.

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

Cited by 8 publications

References 10 publications

Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center

Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center

MRI-Targeted Prostate Biopsy Introduces Grade Inflation and Overtreatment

Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial

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