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?

No AccessJournal of UrologyAdult Urology1 Apr 2018Risk 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? Brian P. Calio, Abhinav Sidana, Dordaneh Sugano, Sonia Gaur, Mahir Maruf, Amit L. Jain, Maria J. Merino, Peter L. Choyke, Bradford J. Wood, Peter A. Pinto, and Baris Turkbey Brian P. CalioBrian P. Calio Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Abhinav SidanaAbhinav Sidana Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Division of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio , Dordaneh SuganoDordaneh Sugano Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Sonia GaurSonia Gaur Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Mahir MarufMahir Maruf Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Amit L. JainAmit L. Jain Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Maria J. MerinoMaria J. Merino Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Peter L. ChoykePeter L. Choyke Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Bradford J. WoodBradford J. Wood Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland , Peter A. PintoPeter A. Pinto Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , and Baris TurkbeyBaris Turkbey Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland View All Author Informationhttps://doi.org/10.1016/j.juro.2017.10.048AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to determine whether saturation of the index lesion during magnetic resonance imaging-transrectal ultrasound fusion guided biopsy would decrease the rate of pathological upgrading from biopsy to radical prostatectomy. Materials and Methods: We analyzed a prospectively maintained, single institution database for patients who underwent fusion and systematic biopsy followed by radical prostatectomy in 2010 to 2016. Index lesion was defined as the lesion with largest diameter on T2-weighted magnetic resonance imaging. In patients with a saturated index lesion transrectal fusion biopsy targets were obtained at 6 mm intervals along the long axis of the index lesion. In patients with a nonsaturated index lesion only 1 target was obtained from the lesion. Gleason 6, 7 and 8-10 were defined as low, intermediate and high risk, respectively. Results: Included in the study were 208 consecutive patients, including 86 with a saturated and 122 with a nonsaturated lesion. Median patient age was 62.0 years (IQR 10.0) and median prostate specific antigen was 7.1 ng/ml (IQR 8.0). The median number of biopsy cores per index lesion was higher in the saturated lesion group (4 vs 2, p <0.001). The risk category upgrade rate from systematic only, fusion only, and combined fusion and systematic biopsy results to prostatectomy was 40.9%, 23.6% and 13.8%, respectively. The risk category upgrade from combined fusion and systematic biopsy results was lower in the saturated than in the nonsaturated lesion group (7% vs 18%, p = 0.021). There was no difference in the upgrade rate based on systematic biopsy between the 2 groups. However, fusion biopsy results were significantly less upgraded in the saturated lesion group (Gleason upgrade 20.9% vs 36.9%, p = 0.014 and risk category upgrade 14% vs 30.3%, p = 0.006). Conclusions: 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. References 1 : Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens: a population-based study. BJU Int2009; 103: 1647. Google Scholar 2 : Biopsy Gleason score: how does it correlate with the final pathological diagnosis in prostate cancer?. Br J Urol1997; 79: 615. 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Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byXue A, Kalapara A, Ballok Z, Levy S, Sivaratnam D, Ryan A, Ramdave S, O'Sullivan R, Moon D, Grummet J and Frydenberg M (2021) 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography Maximum Standardized Uptake Value as a Predictor of Gleason Pattern 4 and Pathological Upgrading in Intermediate-Risk Prostate CancerJournal of Urology, VOL. 207, NO. 2, (341-349), Online publication date: 1-Feb-2022.Song G, Ruan M, Wang H, Fan Y, He Q, Lin Z, Li X, Li P, Wang X, He Z and Zhou L (2020) How Many Targeted Biopsy Cores are Needed for Clinically Significant Prostate Cancer Detection during Transperineal Magnetic Resonance Imaging Ultrasound Fusion Biopsy?Journal of Urology, VOL. 204, NO. 6, (1202-1208), Online publication date: 1-Dec-2020.Leyh-Bannurah S, Kachanov M, Beyersdorff D, Tian Z, Karakiewicz P, Tilki D, Fisch M, Maurer T, Graefen M and Budäus L (2019) Minimum Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsy Cores Needed for Prostate Cancer Detection: Multivariable Retrospective, Lesion Based Analyses of Patients Treated with Radical ProstatectomyJournal of Urology, VOL. 203, NO. 2, (299-303), Online publication date: 1-Feb-2020.Dimitroulis P, Rabenalt R, Nini A, Hiester A, Esposito I, Schimmöller L, Antoch G, Albers P and Arsov C (2018) Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy—Are 2 Biopsy Cores per Magnetic Resonance Imaging Lesion Required?Journal of Urology, VOL. 200, NO. 5, (1030-1034), Online publication date: 1-Nov-2018.Pepe P, Garufi A, Priolo G, Galia A, Fraggetta F and Pennisi M (2018) Is it Time to Perform Only Magnetic Resonance Imaging Targeted Cores? Our Experience with 1,032 Men Who Underwent Prostate BiopsyJournal of Urology, VOL. 200, NO. 4, (774-778), Online publication date: 1-Oct-2018.Smith J (2018) This Month in Adult UrologyJournal of Urology, VOL. 199, NO. 4, (863-864), Online publication date: 1-Apr-2018. Volume 199Issue 4April 2018Page: 976-982 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsriskprostatic neoplasmsneoplasm gradingimage-guided biopsypathologysurgicalMetricsAuthor Information Brian P. Calio Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Equal study contribution. More articles by this author Abhinav Sidana Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Division of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio Equal study contribution. More articles by this author Dordaneh Sugano Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Sonia Gaur Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Mahir Maruf Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Amit L. Jain Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Maria J. Merino Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Peter L. Choyke Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Bradford J. Wood Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland Financial interest and/or other relationship with Philips. More articles by this author Peter A. Pinto Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Baris Turkbey Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...