PD17-11 ADDED VALUE OF CONCOMITANT SYSTEMATIC BIOPSIES IN PREDICTING UPGRADING IN PATIENTS WITH LOCALIZED PROSTATE CANCER DIAGNOSED BY MRI-TARGETED BIOPSY: IMPLICATIONS FOR TREATMENT SELECTION (2019)

You have accessJournal of UrologyProstate Cancer: Staging II (PD17)1 Apr 2019PD17-11 ADDED VALUE OF CONCOMITANT SYSTEMATIC BIOPSIES IN PREDICTING UPGRADING IN PATIENTS WITH LOCALIZED PROSTATE CANCER DIAGNOSED BY MRI-TARGETED BIOPSY: IMPLICATIONS FOR TREATMENT SELECTION Giorgio Gandaglia*, Guillaume Ploussard, Massimo Valerio, Agostino Mattei, Cristian Fiori, Nicola Fossati, Armando Stabile, Jean-Baptiste Beauval, Bernard Malavaud, Mathieu Roumiguié, Daniele Robesti, Paolo Dell’Oglio, Federico Dehò, Umberto Capitanio, Marco Moschini, Stefania Zamboni, Arnas Rakauskas, Francesco De Cobelli, Francesco Porpiglia, Francesco Montorsi, and Alberto Briganti Giorgio Gandaglia*Giorgio Gandaglia* More articles by this author , Guillaume PloussardGuillaume Ploussard More articles by this author , Massimo ValerioMassimo Valerio More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Cristian FioriCristian Fiori More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Armando StabileArmando Stabile More articles by this author , Jean-Baptiste BeauvalJean-Baptiste Beauval More articles by this author , Bernard MalavaudBernard Malavaud More articles by this author , Mathieu RoumiguiéMathieu Roumiguié More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Paolo Dell’OglioPaolo Dell’Oglio More articles by this author , Federico DehòFederico Dehò More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Stefania ZamboniStefania Zamboni More articles by this author , Arnas RakauskasArnas Rakauskas More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555571.08461.66AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Adding systematic cores to MRI-targeted biopsy might improve the detection of clinically significant Prostate Cancer (PCa). Nonetheless, the implications of adding systematic cores in predicting adverse pathology in men undergoing radical prostatectomy (RP) are still unknown. METHODS: Overall, 659 patients who underwent MRI-targeted biopsy and RP between 2016 and 2018 at five referral centers were identified. All patients received concomitant systematic biopsy at the time of targeted biopsy. The D'Amico risk groups and the rate of pathological upgrading were assessed considering grade group at targeted biopsy and after adding information from systematic biopsy. A logistic regression model assessed the impact of MRI-targeted biopsy parameters (PSA, prostate volume, grade group at target biopsy, clinical stage and the diameter of the mpMRI lesion) on the risk of upgrading. A model that included also information on clinically significant PCa outside the index lesion, the number of random positive and total cores was developed. Their discrimination was compared using the area under the curve (AUC). RESULTS: Median PSA was 7.8ng/ml. Targeted biopsy grade group was 1, 2, 3, and ≥4 in 86 (13%), 325 (49.3%), 138 (20.9%) and 110 (17%) patients. When considering also systematic cores, biopsy grade group was 1, 2, 3, and ≥4 in 60 (9%), 333 (50%), 145 (22%) and 121 (18%) men. Overall, 86 (13.1%), 445 (67%) and 128 (19%) patients had low-, intermediate- and high-risk disease at targeted biopsy. When considering information from systematic biopsy, 42 (6.4%), 451 (68%) and 166 (25%) patients had low-, intermediate- and high-risk. While 40 (46%) low-risk patients were reclassified as intermediate-risk, 5 (5.8%) and 33 (7.4%) low- and intermediate-risk patients were reclassified as high-risk. Upgrading decreased from 32% for targeted biopsies to 28% when including information from systematic biopsy (P=0.04). Significant disease at systematic biopsy and a higher number of systematic cores taken were associated with a reduced risk of upgrading (all P≤0.01). The discrimination of a model predicting upgrading including systematic biopsy information was higher compared to including targeted biopsy only (AUC: 78 vs. 72%). CONCLUSIONS: Adding systematic biopsy to targeted cores reduces the risk of upgrading. Our data reinforce the need for accurate systematic biopsy sampling to improve accuracy for tumor grading and to optimize patient selection for active surveillance or focal therapies. Source of Funding: none Milan, Italy; Toulouse, France; Lausanne, Switzerland; Lucerne, Switzerland; Orbassano (Turin), Italy; Milan, Italy; Toulouse, France; Milan, Italy; Lucerne, Switzerland; Lausanne, Switzerland; Milan, Italy; Orbassano (Turin), Italy; Milan, Italy© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e310-e310 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Gandaglia* More articles by this author Guillaume Ploussard More articles by this author Massimo Valerio More articles by this author Agostino Mattei More articles by this author Cristian Fiori More articles by this author Nicola Fossati More articles by this author Armando Stabile More articles by this author Jean-Baptiste Beauval More articles by this author Bernard Malavaud More articles by this author Mathieu Roumiguié More articles by this author Daniele Robesti More articles by this author Paolo Dell’Oglio More articles by this author Federico Dehò More articles by this author Umberto Capitanio More articles by this author Marco Moschini More articles by this author Stefania Zamboni More articles by this author Arnas Rakauskas More articles by this author Francesco De Cobelli More articles by this author Francesco Porpiglia More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...