Introduction:
The role of multiparametric magnetic resonance imaging (MRI) and image-targeted fusion biopsy for the evaluation of prostate cancer has expanded significantly in recent years; however, the accuracy of fusion biopsy for predicting final histopathology after radical prostatectomy (RP) remains under investigation and has not been well evaluated in the community setting. The goal of this study was to assess the accuracy of MRI-fusion biopsy for predicting prostate cancer Grade Group (GG) following RP for a large series of patients in the community setting.
Methods:
The UROCaP Registry is a prospective database of prostate cancer patients maintained by a large academic and community integrated group practice in Chicago, Illinois. We conducted a retrospective chart review of UROCaP patients between 2014 and 2020 and included 278 patients treated with RP after MRI-fusion biopsy for analysis. All fusion biopsies were performed in a standardized fashion, including both 12-core systematic biopsy (SB) and fusion MRI/ultrasound-targeted biopsy (TB) for each region of interest (ROI) identified on prostate MRI as PIRADS ≥3. Biopsies were performed with the UroNav fusion biopsy platform (Koninklijke Philips N.V., Amsterdam, Netherlands). We compared GG on MRI-fusion biopsy (SB+TB) with GG from RP pathology to determine the rate of GG concordance. Cases of GG discordance were evaluated to determine the rate of upgrading. Univariate analysis was performed to assess factors associated with clinically significant upgrading, defined as upgrading by ≥2 Grade Groups.
Results:
Overall, fusion biopsy (SB+TB) accurately predicted final GG after RP in 65.1% (181/278) of patients. When pathology findings from SB and TB were analyzed independently, the rates of GG concordance for SB and TB alone were 29.9% and 55.8%, respectively. Pathological upgrading occurred in 24.1% (67/278) of patients and was considered clinically significant (upgrading by ≥2 Grade Groups) in 5.0% (14/278) of patients. On univariate analysis, prostate-specific antigen (PSA) level (in ng/mL) was associated with clinically significant upgrading for PSA levels ≥4.00 to ≤9.99 (OR 0.33; 95% CI: 0.11-1.01; p = 0.04), ≥10.00 to ≤19.99 (OR 3.55; 95% CI: 1.18-10.73; p = 0.02), and ≥20.00 ng/mL (OR 4.23; 95% CI: 1.07-16.69; p = 0.03).
Conclusion:
When performed in the community setting, pathology from MRI-fusion biopsy (SB+TB) has a reasonably high rate of GG concordance with final surgical pathology and more accurately predicts final pathological GG than either SB or TB alone. While GG upgrading still remains a concern after MRI-fusion biopsy, the rate of clinically significant upgrading (upgrading by ≥2 Grade Groups) is relatively low. Higher PSA levels are associated with an increased risk of clinically significant upgrading after RP. Knowledge regarding the accuracy and limitations MRI-fusion biopsy is becoming increasingly important for counseling patients considering active surveillance, surgery, or definitive radiation therapy.
Funding: N/A
Image(s) (click to enlarge):
Gleason Grade Group Concordance between MRI-Fusion Biopsy and Surgical Pathology at Radical Prostatectomy in a Large Single Center Experience
Category
Prostate Cancer > Potentially Localized
Description
Poster #178
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Presented By: Daniel Simon, MD
Authors:
Daniel Simon, MD
John Smith
John Ogunkeye
Jamaal Jackson, MD
Daniel Roadman, MD
Chris Coogan, MD
Dan Dalton, MD
Paul Yonover, MD FACS