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Performance of systematic, MRI-targeted biopsies alone or in combination for the prediction of unfavourable disease in MRI-positive low-risk prostate cancer patients eligible for active surveillance

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Abstract

Purpose

To assess the upstaging/upgrading rates of low-risk prostate cancer (PCa) according to the biopsy scheme used (systematic (SB), targeted biopsies (TB), or both) in the setting of positive pre-biopsy MRI.

Patients and methods

We included 143 consecutive men fulfilling the Toronto University active surveillance (AS) criteria who underwent a pre-biopsy positive MRI, a combination of SB and software-based fusion TB, and a radical prostatectomy, in two expert centres. The primary endpoints were the pathological upgrading and upstaging rates. Overall unfavourable disease (OUD) was defined by any pT3-4 and/or pN1 and/or ≥ GG 3.

Results

Using TB alone would have missed 21.7% of cancers including 16.7% of ≥ GG 3. The use of TB was significantly associated with a lower risk of ≥ Grade Group (GG) 3 disease (p < 0.006) in RP specimens. Combination of SB and TB lowered this risk by 39%, compared with TB alone. The biopsy scheme did not affect the upstaging rates which were substantial even in case of combination scheme (from 37 to 46%). OUD was detected in approximately 50% of cases. The presence of high grade on TB was the only independent predictive factor for both ≥ GG 2 (p = 0.015) and ≥ GG 3 (p = 0.023) in RP specimens.

Conclusions

High grade on TB biopsies represented the major predictor of upgrading. Combination of SB and TB better defined the sub-group of patients having the lowest risk of reclassification, compared with TB or SB alone. The risk of non-organ-confined disease remained high, and could not be accurately predicted by MRI or systematic/targeted biopsy features.

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Authors and Affiliations

  1. Department of Urology, La Croix du Sud Hospital, IUCT-O, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France

    Guillaume Ploussard, Christophe Almeras, Jean-Romain Gautier, Guillaume Loison, Ambroise Salin & Christophe Tollon

  2. Department of Urology, Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France

    Guillaume Ploussard, Marine Lesourd, Bernard Malavaud & Mathieu Roumiguié

  3. Department of Urology, CHU Toulouse, Toulouse, France

    Jean-Baptiste Beauval, Marine Lesourd, Michel Soulié, Bernard Malavaud & Mathieu Roumiguié

  4. Department of Radiology, La Croix du Sud Hospital, Quint Fonsegrives, France

    Jacques Assoun

  5. Department of Radiology, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France

    Richard Aziza & Daniel Portalez

Authors
  1. Guillaume Ploussard
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  2. Jean-Baptiste Beauval
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  3. Marine Lesourd
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  7. Jean-Romain Gautier
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  8. Guillaume Loison
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  9. Daniel Portalez
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  10. Ambroise Salin
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  13. Bernard Malavaud
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  14. Mathieu Roumiguié
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Contributions

Protocol/project development: GP, BM and MR. Data collection or management: GP, J-BB, ML, CA, JA, RA, J-R G, GL, DP, AS, CT, MS, BM and MR. Data analysis: GP and MR. Manuscript writing/editing: GP, BM and MR.

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Correspondence to Guillaume Ploussard.

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Ploussard, G., Beauval, JB., Lesourd, M. et al. Performance of systematic, MRI-targeted biopsies alone or in combination for the prediction of unfavourable disease in MRI-positive low-risk prostate cancer patients eligible for active surveillance. World J Urol 38, 663–671 (2020). https://doi.org/10.1007/s00345-019-02848-x

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