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The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy

  • Original Article – Clinical Oncology
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Abstract

Purpose

Gleason grading is the strongest predictor of prostate cancer outcome and commonly used to decide for or against the different treatment options. However, Gleason upgrading between systematic transrectal ultrasound-guided prostate biopsy (TRUS-GB) and radical prostatectomy (RPE) has frequently been observed. With respect to the high accuracy of multiparametric MRI (mpMRI) for high-grade cancers and the higher percentage of cancer involvement per biopsy core in targeted MR-guided prostate biopsy (MR-GB), we hypothesized that MR-GB reduces the risk of Gleason upgrading on RPE as compared to the gold standard. The purpose of this study was to compare the rate of Gleason upgrading on RPE for MR-GB, TRUS-GB, and the combination of both biopsy modalities.

Methods

Overall, 52 consecutive patients with RPE had received an mpMRI of the prostate and subsequently underwent targeted MR-GB prior to surgery. All patients underwent an additional TRUS-GB during the same biopsy session. Gleason grading was measured by two different methods: the conventional Gleason score (cGS = primary + secondary pattern) and the highest Gleason pattern (hGP).

Results

In relation to TRUS-GB, MR-GB alone showed lower rates of upgrading when comparing the cGS (40.4 vs. 50.0 %) and the hGP (21.2 vs. 32.7 %). The combination of MR-GB and TRUS-GB showed the lowest rates of upgrading (cGS: 28.8 %; hGP: 11.5 %), and compared to TRUS-GB, significantly reduced the risk of upgrading for both measurements of Gleason grading (cGS: OR 0.41, 95 % CL 0.18–0.91, p = 0.0289; hGP: OR 0.27, 95 % CL 0.10–0.75, p = 0.0123).

Conclusion

MpMRI and targeted MR-GB are useful tools to better characterize and stage the extent of disease, and therefore enable the urologist to better risk-stratify and counsel the patient. The combined use of targeted MR-GB and TRUS-GB presents the least risk of Gleason underestimation.

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References

  • Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757

    Article  PubMed Central  PubMed  Google Scholar 

  • Berg KD, Toft BG, Røder MA, Brasso K, Vainer B, Iversen P (2011) Prostate needle biopsies: interobserver variation and clinical consequences of histopathological re-evaluation. APMIS 119:239–246

    Article  PubMed  Google Scholar 

  • Coard KC, Freeman VL (2004) Gleason grading of prostate cancer: level of concordance between pathologists at the University Hospital of the West Indies. Am J Clin Pathol 122:373–376

    Article  PubMed  Google Scholar 

  • Cohen MS, Hanley RS, Kurteva T et al (2008) Comparing the Gleason prostate biopsy and Gleason prostatectomy grading system: the Lahey Clinic Medical Center experience and an international meta-analysis. Eur Urol 54:371–381

    Article  PubMed  Google Scholar 

  • D’Amico AV, Chen MH, Renshaw AA, Loffredo M, Kantoff PW (2008) Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA 299:289–295

    PubMed  Google Scholar 

  • Dall’Era MA, Albertsen PC, Bangma C et al (2012) Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol 62:976–983

    Article  PubMed  Google Scholar 

  • D’Amico AV, Moul J, Carroll PR, Sun L, Lubeck D, Chen MH (2003) Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol 21:2163–2172

    Article  PubMed  Google Scholar 

  • Epstein JL, Allsbrook WC Jr, Amin MB, Egevad LL (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29:1228–1242

    Article  PubMed  Google Scholar 

  • Fiard G, Hohn N, Descotes JL, Rambeaud JJ, Troccaz J, Long JA (2013) Targeted MRI-guided prostate biopsies for the detection of prostate cancer: initial clinical experience with real-time 3-dimensional transrectal ultrasound guidance and magnetic resonance/transrectal ultrasound image fusion. Urology 81:1372–1378

    Article  PubMed  Google Scholar 

  • Fu Q, Moul JW, Bañez LL et al (2012) Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer. Med Oncol 29:3339–3344

    Article  PubMed  Google Scholar 

  • Gilliland FD, Hoffman RM, Hamilton A et al (1999) Predicting extracapsular extension of prostate cancer in men treated with radical prostatectomy: results from the population based prostate cancer outcomes study. J Urol 162:1341–1345

    Article  CAS  PubMed  Google Scholar 

  • Haffner J, Lemaitre L, Puech P et al (2011) Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int 108(8 Pt 2):E171–E178

    Article  PubMed  Google Scholar 

  • Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent- update 2013. Eur Urol 65:124–137

    Article  PubMed  Google Scholar 

  • Hu Y, Ahmed HU, Carter T et al (2012) A biopsy simulation study to assess the accuracy of several transrectal ultrasonography (TRUS)-biopsy strategies compared with template prostate mapping biopsies in patients who have undergone radical prostatectomy. BJU Int 110:812–820

    Article  PubMed  Google Scholar 

  • Jones CU, Hunt D, McGowan DG et al (2011) Radiotherapy and shortterm androgen deprivation for localized prostate cancer. N Engl J Med 365:107–118

    Article  CAS  PubMed  Google Scholar 

  • Kim JY, Kim SH, Kim YH, Lee HJ, Kim MJ, Choi MS (2014) Low-risk prostate cancer: the accuracy of multiparametric MR imaging for detection. Radiology 271:435–444

    Article  PubMed  Google Scholar 

  • King CR, Long JP (2000) Prostate biopsy grading errors: a sampling problem? Int J Cancer 90:326–330

    Article  CAS  PubMed  Google Scholar 

  • Le JD, Stephenson S, Brugger M et al (2014) Magnetic resonance imaging–ultrasound fusion biopsy for prediction of final prostate pathology. J Urol 192:1367–1373

    Article  PubMed  Google Scholar 

  • McKenney JK, Simko J, Bonham M et al (2011) The potential impact of reproducibility of Gleason grading in men with early stage prostate cancer managed by active surveillance: a multi-institutional study. J Urol 186:465–469

    Article  PubMed  Google Scholar 

  • Palisaar RJ, Graefen M, Karakiewicz PI et al (2002) Assessment of clinical and pathologic characteristics predisposing to disease recurrence following radical prostatectomy in men with pathologically organ-confined prostate cancer. Eur Urol 41:155–161

    Article  PubMed  Google Scholar 

  • Pepe P, Aragona F (2013) Morbidity after transperineal prostate biopsy in 3000 patients undergoing 12 vs 18 vs more than 24 needle cores. Urology 81:1142–1146

    Article  PubMed  Google Scholar 

  • Porter CR, Kodama K, Gibbons RP et al (2006) 25-year prostate cancer control and survival outcomes: a 40-year radical prostatectomy single institution series. J Urol 176:569–574

    Article  PubMed  Google Scholar 

  • Quentin M, Blondin D, Arsov C et al (2014) Prospective evaluation of MRI-guided in- bore prostate biopsy versus systematic transrectal ultrasound (TRUS)-guided prostate biopsy in biopsy-naïve men with elevated prostate-specific antigen (PSA) levels. J Urol 192:1374–1379

    Article  PubMed  Google Scholar 

  • Rastinehad AR, Turkbey B, Salami SS et al (2013) Improving detection of clinically significant prostate cancer: MRI/TRUS fusion-guided prostate biopsy. J Urol 191:1749–1754

    Article  PubMed  Google Scholar 

  • Schimmöller L, Quentin M, Arsov C et al (2014) MR-sequences for prostate cancer diagnostics: validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy. Eur Radiol 24:2582–2589

    Article  PubMed  Google Scholar 

  • Servoll E, Saeter T, Vlatkovic L et al (2012) Impact of a tertiary Gleason pattern 4 or 5 on clinical failure and mortality after radical prostatectomy for clinically localised prostate cancer. BJU Int 109:1489–1494

    Article  PubMed  Google Scholar 

  • Sgrignoli AR, Walsh PC, Steinberg GD, Steiner MS, Epstein JI (1994) Prognostic factors in men with stage D1 prostate cancer: identification of patients less likely to have prolonged survival after radical prostatectomy. J Urol 152:1077–1081

    CAS  PubMed  Google Scholar 

  • Siddiqui MM, Rais-Bahrami S, Truong H et al (2013) Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 64:713–719

    Article  PubMed  Google Scholar 

  • Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J (2012) Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy—should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect 18:575–581

    Article  CAS  PubMed  Google Scholar 

  • Thompson J, Lawrentschuk N, Frydenberg M, Thompson L, Stricker P (2013) The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int 112(Suppl 2):6–20

    Article  PubMed  Google Scholar 

  • Turker P, Bas E, Bozkurt S et al (2013) Presence of high grade tertiary Gleason pattern upgrades the Gleason sum score and is inversely associated with biochemical recurrence-free survival. Urol Oncol 31:93–98

    Article  PubMed  Google Scholar 

  • Wysock JS, Rosenkrantz AB, Huang WC et al (2014) A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial. Eur Urol 66:343–351

    Article  PubMed  Google Scholar 

  • Zhou P, Chen MH, McLeod D, Carroll PR, Moul JW, D’Amico AV (2005) Predictors of prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Clin Oncol 23:6992–6998

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Christian Arsov.

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Arsov, C., Becker, N., Rabenalt, R. et al. The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy. J Cancer Res Clin Oncol 141, 2061–2068 (2015). https://doi.org/10.1007/s00432-015-1991-5

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  • DOI: https://doi.org/10.1007/s00432-015-1991-5

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