MP53-10 ASSOCIATION OF SYSTEMATIC BIOPSY VS. MAGNETIC RESONANCE IMAGING/ULTRASOUND FUSION TARGETED BIOPSY WITH PROSTATE CANCER UPSTAGING AT RADICAL PROSTATECTOMY

This clinical guideline focuses on: 1) the use of multiparametric magnetic resonance imaging (mpMRI) in diagnosing clinically significant prostate cancer (CSPC) in patients with an elevated risk of CSPC and who are biopsy-naïve; and 2) the use of mpMRI in diagnosing CSPC in patients with a persistently elevated risk of having CSPC and who have a negative transrectal ultrasound (TRUS)-guided systematic biopsy.The methods of the Practice Guideline Development Cycle were used. MEDLINE, EMBASE, the Cochrane Library (1997‒April 2014), main guideline websites, and relevant annual meeting abstracts (2011‒2014) were searched. Internal and external reviews were conducted.The two main recommendations are:Recommendation 1: In patients with an elevated risk of CSPC (according to prostate-specific antigen [PSA] levels and/or nomograms) who are biopsy-naïve: mpMRI followed by targeted biopsy (biopsy directed at cancer-suspicious foci detected with mpMRI) should not be considered the standard of care; data from future research studies are essential and should receive high-impact trial funding to determine the value of mpMRI in this clinical context.Recommendation 2:In patients who had a prior negative TRUS-guided systematic biopsy and demonstrate an increasing risk of having CSPC since prior biopsy (e.g., continued rise in PSA and/or change in findings from digital rectal examination): mpMRI followed by targeted biopsy may be considered to help in detecting more CSPC patients compared with repeated TRUS-guided systematic biopsy.

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Prostate Magnetic Resonance Imaging, with or Without Magnetic Resonance Imaging-targeted Biopsy, and Systematic Biopsy for Detecting Prostate Cancer: A Cochrane Systematic Review and Meta-analysis

European Urology ◽

10.1016/j.eururo.2019.06.023 ◽

2020 ◽

Vol 77 (1) ◽

pp. 78-94 ◽

Cited By ~ 43

Author(s):

Frank-Jan H. Drost ◽

Daniel Osses ◽

Daan Nieboer ◽

Chris H. Bangma ◽

Ewout W. Steyerberg ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Systematic Review ◽

Magnetic Resonance ◽

Meta Analysis ◽

Targeted Biopsy ◽

Resonance Imaging ◽

Cochrane Systematic Review ◽

Systematic Biopsy

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Focused Submission of Tissue for Radical Prostatectomy Following Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-Targeted Biopsy

International Journal of Surgical Pathology ◽

10.1177/1066896919865026 ◽

2019 ◽

Vol 28 (1) ◽

pp. 44-50

Author(s):

Danielle Fasciano ◽

Marie-Lisa Eich ◽

Maria del Carmen Rodriguez Pena ◽

Soroush Rais-Bahrami ◽

Jennifer Gordetsky

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Radical Prostatectomy ◽

Prostate Biopsy ◽

Margin Status ◽

Targeted Biopsy ◽

Resonance Imaging ◽

Grade Group ◽

Significant Difference

Prostate cancer can be difficult to appreciate grossly and therefore partial sampling of the gland can lead to incorrect grading, staging, or margin status. However, submitting the entire prostate is more time consuming and costly. We investigated the use of magnetic resonance imaging/ultrasound-targeted biopsy for the selective submission of prostatectomy specimens. We performed a retrospective review for patients with cancer on targeted prostate biopsy who underwent subsequent radical prostatectomy. Prostatectomy specimens were submitted in their entirety and assessed for Grade Group, extraprostatic extension (EPE), margins, and number of blocks. For Targeted-Grossing (TG) assessment, apex margin, bladder neck margin, seminal vesicles, and vas deferens sections were included. For the remainder of the prostate, only sections from areas shown to be positive for cancer on targeted biopsy were included in the analysis. With total tissue submission, EPE was found in 39/81 (48.1%) cases and positive margins in 19/81 (23.5%) cases. The TG method required significantly fewer blocks: 15.8 ± 5.9 versus 44.9 ± 11.9 ( P < .0001). The TG method would have diagnosed the correct stage in 73/81 (90.1%) cases, Grade Group in 74/81 (91.4%) cases, and margin status in 79/81 (97.5%) cases. EPE was missed completely by the TG method in 7 cases ( P = .008), of which 5/7 (71.4%) had focal EPE. There was no significant difference in stage ( P = .24), Grade Group ( P = .95), or margin status ( P = .16) between the 2 methods. Grossing utilizing selective tissue submission from areas found to be positive for prostate cancer on magnetic resonance imaging/ultrasound-targeted prostate biopsy remains inferior to complete submission of tissue for radical prostatectomy specimens.

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Comparison of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy With Systematic Biopsy Alone for the Diagnosis of Prostate Cancer

JAMA Network Open ◽

10.1001/jamanetworkopen.2019.8427 ◽

2019 ◽

Vol 2 (8) ◽

pp. e198427 ◽

Cited By ~ 11

Author(s):

Martha M. C. Elwenspoek ◽

Athena L. Sheppard ◽

Matthew D. F. McInnes ◽

Samuel W. D. Merriel ◽

Edward W. J. Rowe ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Targeted Biopsy ◽

Resonance Imaging ◽

Multiparametric Magnetic Resonance Imaging ◽

Systematic Biopsy

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Prostate Cancers Detected by Magnetic Resonance Imaging–Targeted Biopsies Have a Higher Percentage of Gleason Pattern 4 Component and Are Less Likely to Be Upgraded in Radical Prostatectomies

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0410-oa ◽

2018 ◽

Vol 143 (1) ◽

pp. 86-91 ◽

Cited By ~ 3

Author(s):

Yani Zhao ◽

Fang-Ming Deng ◽

Hongying Huang ◽

Peng Lee ◽

Hebert Lepor ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Radical Prostatectomy ◽

Targeted Biopsy ◽

Resonance Imaging ◽

Gleason Pattern ◽

Magnetic Resonance Imaging Mri ◽

Prostate Cancers ◽

Targeted Biopsies

Context.— In Gleason score (GS) 7 prostate cancers, the quantity of Gleason pattern 4 (GP 4) is an important prognostic factor and influences treatment decisions. Magnetic resonance imaging (MRI)–targeted biopsy has been increasingly used in clinical practice. Objective.— To investigate whether MRI-targeted biopsy may detect GS 7 prostate cancer with greater GP 4 quantity, and whether it improves biopsy/radical prostatectomy GS concordance. Design.— A total of 243 patients with paired standard and MRI-targeted biopsies with cancer in either standard or targeted or both were studied, 65 of whom had subsequent radical prostatectomy. The biopsy findings, including GS and tumor volume, were correlated with the radical prostatectomy findings. Results.— More prostate cancers detected by MRI-targeted biopsy were GS 7 or higher. Mean GP 4 percentage in GS 7 cancers was 31.0% ± 29.3% by MRI-targeted biopsy versus 25.1% ± 29.5% by standard biopsy. A total of 122 of 218 (56.0%) and 96 of 217 (44.2%) prostate cancers diagnosed on targeted biopsy and standard biopsy, respectively, had a GP 4 of 10% or greater (P = .01). Gleason upgrading was seen in 12 of 59 cases (20.3%) from MRI-targeted biopsy and in 24 of 57 cases (42.1%) from standard biopsy (P = .01). Gleason upgrading correlated with the biopsy cancer volume inversely and GP 4 of 30% or less in standard biopsy. Such correlation was not found in MRI-targeted biopsy. Conclusions.— Magnetic resonance imaging–targeted biopsy may detect more aggressive prostate cancers and reduce the risk of Gleason upgrading in radical prostatectomy. This study supports a potential role for MRI-targeted biopsy in the workup of prostate cancer and inclusion of percentage of GP 4 in prostate biopsy reports.

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