Value of Tracking Biopsy in Men Undergoing Active Surveillance of Prostate Cancer.
PURPOSE
We compared the upgrading rate obtained by resampling precise spots of prostate cancer (tracking biopsy) vs conventional systematic resampling during followup of men on active surveillance.


MATERIALS AND METHODS
From 2009 to 2017 in 352 men prostate cancer was Gleason 3 + 3 in 268 and Gleason 3 + 4 in 84 at initial magnetic resonance imaging-ultrasound fusion biopsy. These men subsequently underwent a second fusion biopsy. At the first biopsy session all men underwent 12-core systematic biopsies and, when magnetic resonance imaging visible lesions were present, targeted biopsies. All cancerous sites were recorded electronically. During active surveillance at a second fusion biopsy session 6 to 18 months later tracking and systematic nontracking samples were obtained. The primary outcome measure was an increase in Gleason score (upgrading) at followup sampling, which was stratified by biopsy method.


RESULTS
Overall 91 of the 352 men (25.9%) experienced upgrading at the second biopsy during a median 11-month interval. The upgrade rate in the Gleason 3 + 3 and 3 + 4 groups was 26.9% and 22.6%, respectively. The mean number of cores taken at second biopsy was 12.2 ± 3.3 in men with upgrading and 12.4 ± 4.1 in those who remained stable (p not significant). Men with grade 0 to 4 magnetic resonance imaging targets were all upgraded at approximately the same rate of 20% to 30% (p not significant). However, 58.8% of the men with grade 5 magnetic resonance imaging targets were upgraded. Of the 91 upgrades 48 (53%) were detected only by tracking.


CONCLUSIONS
The tracking function of magnetic resonance imaging-ultrasound fusion biopsy warrants further study. When specific sites are resampled in men undergoing active surveillance of prostate cancer, upgrading is detected more often than by nontracking biopsy.
['Chang|Edward|E|', 'Jones|Tonye A|TA|', 'Natarajan|Shyam|S|', 'Sharma|Devi|D|', 'Simopoulos|Demetrios|D|', 'Margolis|Daniel J|DJ|', 'Huang|Jiaoti|J|', 'Dorey|Frederick J|FJ|', 'Marks|Leonard S|LS|']
D000368:Aged D006801:Humans D061705:Image-Guided Biopsy D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D064847:Multimodal Imaging D060787:Neoplasm Grading D011159:Population Surveillance D011471:Prostatic Neoplasms D014463:Ultrasonography
biopsy magnetic resonance imaging neoplasm grading prostatic neoplasms ultrasonography