Pathologic correlation of transperineal in-bore 3-Tesla magnetic resonance imaging-guided prostate biopsy samples with radical prostatectomy specimen

Abstract

Purpose To determine the accuracy of in-bore transperineal 3-Tesla (T) magnetic resonance (MR) imaging-guided prostate biopsies for predicting final Gleason grades in patients who subsequently underwent radical prostatectomy (RP). Methods A retrospective review of men who underwent transperineal MR imaging-guided prostate biopsy (tpMRGB) with subsequent radical prostatectomy within 1 year was conducted from 2010–2015. All patients underwent a baseline 3-T multiparametric MRI (mpMRI) with endorectal coil and were selected for biopsy based on MR findings of a suspicious prostate lesion and high degree of clinical suspicion for cancer. Spearman correlation was performed to assess concordance between tpMRGB and final RP pathology among patients with and without previous transrectal ultrasound (TRUS)-guided biopsies. Results A total of 24 men met all eligibility requirements, with a median age of 65 years (interquartile range [IQR] 11.7). The median time from biopsy to RP was 85 days (IQR 50.5). Final pathology revealed Gleason 3+4=7 in 12 patients, 4+3=7 in 10 patients, and 4+4=8 in 2 patients. A strong correlation (ρ: +0.75, p<0.001) between tpMRGB and RP results was observed, with Gleason scores concordant in 17 cases (71%). 16 of the 24 patients underwent prior TRUS biopsies. Subsequent tpMRGB revealed Gleason upgrading in 88% of cases, which was concordant with RP Gleason scores in 69% of cases (ρ: +0.75, p<0.001). Conclusion Final Gleason scores diagnosed by tpMRGB at 3-T correlate strongly with final RP surgical pathology. This may facilitate prostate cancer diagnosis, particularly in patients with negative or low-grade TRUS biopsy results in whom clinically significant cancer is suspected or detected on mpMRI.

Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning

“…Five patients were upstaged to higher-risk groups, indicating more involved definitive therapy. Even with the application of modern imaging and the novel DynaCAD system for MRI-fusion biopsies, our concordance results are consistent with previously published reports ( 13 – 15 ) and suggest the need for sincere equipoise in delivering partial prostate therapy.…”

“…A major limitation of mpMRI-directed partial gland therapy is the variable concordance between imaging and histopathology (13)(14)(15). Rates in the literature range from 12.1% to 69.7% when assessing the accuracy of mpMRI based on confirmatory biopsies and vary depending on Prostate Imaging Reporting and Data System (PIRADS) risk (4,5,13,16).…”

Evolution of prostate cancer diagnosis: retrospective analysis of magnetic resonance imaging/ultrasound fusion guided biopsies protocol in routine practice and patients management

“…Concerning surgery outcomes, Velez et al reported their histological results on patients who had radical prostatectomy after fusion biopsy (29). Gleason scores were unchanged in 71% of cases with a Spearman correlation coefficient of 0.75, which is comparable to our study results.…”

The factors predicting upgrading of prostate cancer by using International Society for Urological Pathology (ISUP) 2014 Gleason grading system

“…Magnetic resonance imaging (MRI) in prostate cancer allows the opportunity for disease staging and targeted biopsy. [20][21][22] Prostate biopsies performed with the aid of fusion-guided MRI/ultrasonography (US), detected 14.3% of prostate cancers that could not be detected using standard 12-core prostate biopsy. Diagnosis by using fusion biopsy, 86.7% of patients had clinically significant prostate cancer.…”