Pathological findings at radical prostatectomy of biopsy naïve men diagnosed with MRI targeted biopsy alone without concomitant standard systematic sampling.
OBJECTIVES
To test international society of urological pathology grade group (ISUP GG) concordance rates between multiparametric magnetic resonance imaging (mpMRI) targeted biopsies (TB) vs. standard systematic biopsies (SB) and radical prostatectomy (RP) specimens, in biopsy naïve patients.


MATERIALS AND METHODS
This retrospective single center study included 80 vs. 500 biopsy naïve patients diagnosed with TB vs. SB and treated with RP between 2015 and 2018. First, we compared ISUP GG concordance rates and the percentages of undetected clinically significant prostate cancer (csPCa: ISUP GG  ≥ 3), between TB vs. SB and RP. Second, multivariable logistic regression models tested predictors of concordance rates before and after 1:3 propensity score (PS) matching. Third, among TB patients, univariable logistic regression models tested variables associated with ISUP GG concordance at RP.


RESULTS
Overall, ISUP GG concordance rates were, respectively, 55 vs. 41.4% for TB vs. SB (P = 0.02). However, no differences in concordance rates were observed in patients with biopsy ISUP GG1 (31 vs. 33.9% for TB vs. SB; P = 0.8). Moreover, 15 vs. 18.8% csPCa were missed by TB vs. SB, respectively (P = 0.4). In multivariable logistic regression models, TB were associated with higher concordance rates before (odds ratio [OR]: 1.13; P = 0.04) and after 1:3 PS matching (OR: 1.15; P 0.03), compared to SB. In TB patients, age (OR: 0.98; P = 0.04), maximum cancer core involvement (MCCI; OR: 1.02; P = 0.02) and maximum cancer core length (MCCL; OR: 1.01; P = 0.07) were associated with ISUP GG concordance. Moreover, a trend for lower concordance rates was observed with higher PSA-D (OR: 0.77; P = 0.1). Finally, intermediate lesion location at mpMRI was associated with lowest concordance rates (44%).


CONCLUSION
In biopsy naïve patients treated with RP, TB achieved higher rates of ISUP GG concordance, but same percentages of csPCa missed, compared to SB. Moreover, only patients with ISUP GG ≥2, but not patients with ISUP GG1, exhibited higher concordance rates. Finally, age, MCCI, MCCL, PSA-D, and lesion location were associated with concordance between TB and RP.
['Luzzago|Stefano|S|', 'Petralia|Giuseppe|G|', 'Maresca|Duilia|D|', 'Sabatini|Ilaria|I|', 'Cordima|Giovanni|G|', 'Brescia|Antonio|A|', 'Verweij|Fabrizio|F|', 'Garelli|Giulia|G|', 'Mistretta|Francesco A|FA|', 'Cioffi|Antonio|A|', 'Pricolo|Paola|P|', 'Alessi|Sarah|S|', 'Ferro|Matteo|M|', 'Matei|Deliu-Victor|DV|', 'Renne|Giuseppe|G|', 'de Cobelli|Ottavio|O|', 'Musi|Gennaro|G|']
D000328:Adult D000368:Aged D006801:Humans D061705:Image-Guided Biopsy D008297:Male D008875:Middle Aged D000081364:Multiparametric Magnetic Resonance Imaging D011467:Prostate D011468:Prostatectomy D011471:Prostatic Neoplasms D012189:Retrospective Studies
Radical prostatectomy Targeted biopsies Multiparametric magnetic resonance imaging ISUP grade groups Standard biopsies