MP53-20 ACCURACY OF MRI-TARGETED BIOPSY TO RECLASSIFY GLEASON GRADE IN MEN ON ACTIVE SURVEILLANCE (2015)

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2015MP53-20 ACCURACY OF MRI-TARGETED BIOPSY TO RECLASSIFY GLEASON GRADE IN MEN ON ACTIVE SURVEILLANCE Pedro Recabal, Melissa Assel, Dan Lee, Oguz Akin, Jonathan Coleman, Alan Thong, Justin Lee, James Eastham, Evis Salas, Peter Scardino, Alberto Vargas, and Behfar Ehdaie Pedro RecabalPedro Recabal More articles by this author , Melissa AsselMelissa Assel More articles by this author , Dan LeeDan Lee More articles by this author , Oguz AkinOguz Akin More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Alan ThongAlan Thong More articles by this author , Justin LeeJustin Lee More articles by this author , James EasthamJames Eastham More articles by this author , Evis SalasEvis Salas More articles by this author , Peter ScardinoPeter Scardino More articles by this author , Alberto VargasAlberto Vargas More articles by this author , and Behfar EhdaieBehfar Ehdaie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1714AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason grade upgrade is the most accepted trigger for treatment for men on active surveillance (AS). Studies suggest an increasing role of MRI in the diagnosis and management of prostate cancer. Our goal was to determine the accuracy of MRI-targeted biopsy to reclassify men on AS. We sought to assess whether MRI-targeted biopsies may be used instead of systematic biopsy or determine if biopsy might be avoided in men on AS without an MRI lesion. METHODS 135 consecutive men with prostate cancer on AS were biopsied by one of two surgeons (BE, JC) from January to September 2014. Eligibility for AS included Gleason score 6, PSA¡Ü20, and clinical tumor stage ¡Ü2a. All patients on AS received an multiparametric MRI prior to biopsy and lesions found on the MRI were graded by dedicated uro-radiologists using a standardized 5-point scale. Imaging was performed at least 3 months after diagnostic biopsy or every two or three years for men on AS. In patients with an MRI lesion with a score 3, an MRI-targeted biopsy of the lesion was followed by a standard biopsy of the remaining prostate. Standard 14-core biopsy was performed for patients without a lesion on MRI (score <3). We evaluated the sensitivity and specificity of MRI-targeted biopsy stratified by MRI lesion score to identify Gleason grade upgrade. RESULTS 121 (90%) had at least one MRI lesion with a score ¡Ý3. The probability of reclassification to Gleason grade ¡Ý3+4 was 7% for MRI score < 3 (n=14, 95% CI 0.2%, 34%), and 38%, 43% and 100% for MRI lesion score 3 (n=16), 4 (n=95) and 5 (n=10), respectively. The proportion of men with Gleason grade ¡Ý3+4 that would be missed if only MRI lesions were biopsied is demonstrated in figure 2. MRI-targeted biopsy missed 19% and 15% of significant cancers in men with an MRI score of 3 and 4, respectively. All patients with MRI score 5 lesions were reclassified, but 1 patient (10%) was missed using MRI-targeted biopsy. CONCLUSIONS Among men with prostate cancer managed with AS and monitored with multiparametric MRI, the rate of reclassification to Gleason score ¡Ý3+4 is associated with increasing MRI lesion score. A technique that uses only MRI-targeted biopsy of the MRI detected lesions results in a proportion of significant cancers missed. Systematic biopsy and MRI-targeted biopsy to the MRI lesion areas are required to monitor men on AS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e643 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pedro Recabal More articles by this author Melissa Assel More articles by this author Dan Lee More articles by this author Oguz Akin More articles by this author Jonathan Coleman More articles by this author Alan Thong More articles by this author Justin Lee More articles by this author James Eastham More articles by this author Evis Salas More articles by this author Peter Scardino More articles by this author Alberto Vargas More articles by this author Behfar Ehdaie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...