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Minerva Urologica e Nefrologica 2019 Oct 10

DOI: 10.23736/S0393-2249.19.03367-8

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Risk of Gleason Score 3 + 4 = 7 prostate cancer upgrading at radical prostatectomy is significantly reduced by target biopsy compared to standard biopsy technique

Stefano DE LUCA 1, Cristian FIORI 1, Enrico BOLLITO 2, Diletta GARROU 1, Roberta AIMAR 1, Giovanni CATTANEO 1, Sabrina DE CILLIS 1, Matteo MANFREDI 1, Daniele TOTA 2, Federica MASSA 2, Roberto PASSERA 3, Francesco PORPIGLIA 1

1 Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Turin, Italy; 2 Pathology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Turin, Italy; 3 Nuclear Medicine, San Giovanni Battista Hospital and University of Turin, Orbassano, Turin, Italy


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BACKGROUND: To evaluate if multiparametric magnetic resonance (mpMRI)- transrectal ultrasound (TRUS) fusion targeted biopsy (TBx) versus untargeted standard biopsy (SBx) may decrease the rate of pathological upgrading of Gleason score (GS) 3+4 prostate cancer (PCa) at radical prostatectomy (RP). We also evaluated the impact of percent pattern 4 and cribriform glands at biopsy in the risk of GS 3 + 4 = 7 upgrading.
METHODS: 301 patients with GS 3+4 PCa on biopsy (159 SBx and 142 TBx) who underwent laparoscopic robot-assisted RP were sequentially enrolled. Histological data from RP sections were used as reference standard. The concordance of biopsy with pathological GS, as well as the GS 3+4 upgrading at RP were evaluated in different univariate and multivariate binary logistic regression models, testing age, PSA, fPSA%, tumor volume, PI-RADS, clinical stage, percentage of Gleason pattern 4 (GP) and/or presence of cribriform sub-type at biopsy.
RESULTS: Of the 301 biopsies, the median of GP 4 was 16% of the tissue. Minimal GP 4 (≤ 16%) cancers had a significant lower median volume (1.7 ml) than those with GP4 >16% (2.9 ml), (p<0.001). Pathological GS 3+4 was confirmed for 58.8% and 82.2% for SBx and TBx patients, respectively. The rate of upgraded and downgraded GS on SBx versus TBx was 38.8% vs. 16.7% and 1.8% and 2.1%, respectively. The rate of upgrading was significantly associated with the presence of GP4 >16% versus ≤16% (OR 4.4, 95% CI 1.4-12.0; p=0.021) and with the presence of cribriform sub-type at biopsy specimens (OR 6.2, 95% CI 2.2-18.7; p<0.001).
CONCLUSIONS: We demonstrated that TBx technique significantly reduced the risk of GS 3+4 upgrading at RP, compared to SBx one. The rate of upgrading wassignificantly associated with GP4>16%, mostly when cribriform sub-type was present at biopsy specimens.


KEY WORDS: Prostate cancer; Magnetic resonance imaging; Prostate biopsy; Radical prostatectomy; Gleason score

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