Risk of Upgrading from Prostate Biopsy to Radical Prostatectomy Pathology—Does Saturation Biopsy of Index Lesion during Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy Help?

Calio, Brian; Sidana, Abhinav; Sugano, Dordaneh; Gaur, Sonia; Maruf, Mahir; Jain, Amit; Merino, María J.; Choyke, Peter L.; Wood, Bradford J.; Pinto, Peter A.; Türkbey, Barış

doi:10.1016/j.juro.2017.10.048

Cited by 96 publications

(62 citation statements)

References 26 publications

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“…Accordingly, the use of mp‐MRI should be offered before prostate biopsies with the aim of reducing GU risk in the final pathology. In a study with 208 consecutive patients, the higher number of biopsy cores taken from suspected areas in mp‐MRI were shown to significantly reduce the risk of GU . In addition, Boesen et al reported a 44% PCa detection rate in the second biopsy in patients who had a previous history of negative TRUS biopsy.…”

Section: Discussionmentioning

confidence: 98%

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The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

et al. 2019

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Background Active surveillance (AS) is one of the treatment alternatives in low‐risk prostate cancer (PCa). The pathological upgrading after radical prostatectomy (RP) were investigated in patients who were eligible for AS in the present study. Methods Between August 2006 and July 2017, 627 patients underwent RP in our institution. One hundred and thirty‐six patients who were eligible for AS at the time of RP were included in this study. The previously defined AS criteria Gleason 3 + 3=6 adenocarcinoma at maximum two biopsy cores, prostate‐specific antigen (PSA) < 10 ng/mL and clinical T stage ≤ 2a were used in the study. The demographics, clinical, and histopathological outcomes were retrospectively compared between two groups, which were divided in accordance with the upgrading status at final pathology as Group 1 (n = 67, upgrading) and Group 2 (n = 69, nonupgrading). Results Gleason upgrading (GU) was found in 67 (49.3%) patients, and 17 patients (12.5%) were upstaged to pT3a. The upgrading to Gleason 3 + 4 was reported in 38.7% of patients, however, 7.4%, and 3.7% of the patients were upgraded to Gleason 4 + 3, and Gleason 4 + 4, respectively. The 10.3% of the patients had extraprostatic involvement, and the rate (19.4% vs 1.4%, P = .002) was significantly higher in Group 1. PSA density (P = .001), tumor size (P < .001), tumor percentage (P < .001), apical involvement (P = .013), and perineural invasion (P < .001) in RP specimen were higher in Group 1. Multivariate analysis showed that perineural invasion (OR = 4.26; 95%CI: 1.76‐10.33; P = .001) and pathologic T stage (OR = 5.45; 95%CI: 1.08‐27.4; P = .04) were independently associated with GU. Conclusions Since 12.5% of the patients upstaged to pT3a disease, and there is a possible risk of Gleason 4 pattern, upgrading of the tumor should carefully be kept in mind before offering AS to low‐risk patients with PCa.

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Section: Discussionmentioning

confidence: 98%

“…In a study with 208 consecutive patients, the higher number of biopsy cores taken from suspected areas in mp-MRI were shown to significantly reduce the risk of GU. 23 In addition, Boesen et al 24…”

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confidence: 99%

The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

et al. 2019

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“…26 Recently, it has been shown that in men with high risk ROI, performing a saturation biopsy of the ROI can decrease the rate and risk of Gleason grade upgrading at RP. 27 Thus, in men with heterogeneous ROI found on prebiopsy MRI, more than 2 cores of the ROI should be considered to improve cancer assessment. Lastly, the detection of clinically significant cancer using MRI is limited by the amount of cancer present.…”

Section: Discussionmentioning

confidence: 99%

Persistent Discordance in Grade, Stage, and NCCN Risk Stratification in Men Undergoing Targeted Biopsy and Radical Prostatectomy

Alshak

Patel

Groß

et al. 2020

Urology

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“…In our study of neoadjuvant ADT plus enzalutamide, we hypothesized that mpMRI prior to surgery would assess radiographic tumor response compared with baseline imaging, while also providing biopsy targets for molecular and histologic examination of pre-treatment foci. Given the high-risk population for whom neoadjuvant intense ADT is suggested to benefit, patients on our study with larger lesions on mpMRI undergo saturation biopsy of imaging targets, to more accurately assess tumor heterogeneity 15,16 .…”

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confidence: 99%

A case report of multiple primary prostate tumors with differential drug sensitivity

et al. 2020

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Localized prostate cancers are genetically variable and frequently multifocal, comprising spatially distinct regions with multiple independently-evolving clones. To date there is no understanding of whether this variability can influence management decisions for patients with prostate tumors. Here, we present a single case from a clinical trial of neoadjuvant intense androgen deprivation therapy. A patient was diagnosed with a large semi-contiguous tumor by imaging, histologically composed of a large Gleason score 9 tumor with an adjacent Gleason score 7 nodule. DNA sequencing demonstrates these are two independent tumors, as only the Gleason 9 tumor harbors single-copy losses of PTEN and TP53. The PTEN/TP53deficient tumor demonstrates treatment resistance, selecting for subclones with mutations to the remaining copies of PTEN and TP53, while the Gleason 7 PTEN-intact tumor is almost entirely ablated. These findings indicate that spatiogenetic variability is a major confounder for personalized treatment of patients with prostate cancer.

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Risk of Upgrading from Prostate Biopsy to Radical Prostatectomy Pathology—Does Saturation Biopsy of Index Lesion during Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy Help?

Abstract: Our results demonstrate that saturation of the index lesion significantly decreases the risk of upgrading on radical prostatectomy by minimizing the impact of tumor heterogeneity.

Cited by 96 publications

References 26 publications

The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

Persistent Discordance in Grade, Stage, and NCCN Risk Stratification in Men Undergoing Targeted Biopsy and Radical Prostatectomy

A case report of multiple primary prostate tumors with differential drug sensitivity

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