AUA 2018: Prostate Biopsy Centralization at High Volume, Tertiary Care Centers Represents the Most Refined Diagnostic Tool for Prostate Cancer Patients

San Francisco, CA (UroToday.com) In an increasingly individualized prostate cancer (PCa) care, discordance between prostate biopsy and radical prostatectomy (RP) should be minimal. In tertiary care centers prostate biopsies may be performed more accurately due to adherence to strict protocols. In this study the authors aimed to evaluate the impact of centralized biopsy on PCa diagnostic accuracy.

For this purpose, 515 patients treated with RP between 2015 and 2017 were evaluated. Patients were divided in two Groups: 
1. Men undergoing trans-rectal prostate biopsy at the authors’ institution (n=261; 50.7%) 
2. Men undergoing biopsy at other Institutions but whose biopsies were prospectively reviewed by a single expert uro-pathologist (n=254; 49.3%). 

Descriptive analyses assessed the discordance between centralized and revised biopsy by number of cores taken, total and single core length. Discordance between Gleason score (GS)/ISUP grade groups (PCg) at biopsy and final pathology was also examined. 

After stratification according to biopsy site, patients in Group 1 had a higher number of cores taken (8 vs. 6), higher total cores length (19.5 vs. 13.3 cm) and higher single core length (1.31 vs. 1.01 cm; all p=0.02). The overall discordance between biopsy and RP

GS was 47.1%. A significant discordance (2 PCgs between biopsy and RP) was observed in 40 patients (8.3%). The overall discordance rate in GS between biopsy and RP in Group 1 was lower (40.6 vs. 53.9%, respectively; p<0.001). Multivariable analyses demonstrated that patients in Group 1 and patients with PCg2 at biopsy were significantly less likely to experience GS discordance (OR:0.71, p=0.002 and 0.58, p=0.03, respectively). The accuracy of the model was 69.9%. The model including patients in Group 1 was significantly more accurate in predicting GS discordance as compared to the model performed in patients in Group 2 (73.8 vs. 65.3%; p=0.003).

Figure 1 – Multivariable analysis predicting discordance between biopsy and RP:
UroToday AUA2018 MVA Predicting Discordance

In conclusion, prostate biopsies performed at a tertiary care center are roughly 10% more accurate in pathological GS prediction, even when centralized histological revision is performed. This most likely is due to the quality of biopsy. Therefore, the authors recommend, that when possible, prostate biopsies should be performed at tertiary care centers in order to optimize diagnostic accuracy.

Presented by: Marco Bianchi, Milan, Italy
Co-Author: Carlo Andrea Bravi, Nicola Fossati, Giorgio Gandaglia, Emanuele Zaffuto, Simone Scuderi, Elio Mazzone, Umberto Capitanio, Nazareno Suardi, Milan, Italy, Pierre I. Karakiewicz, Montreal, Canada, Rodolfo Montironi, Ancona, Italy, Vincenzo Mirone, Naples, Italy, Massimo Freschi, Claudio Doglioni, Francesco Montorsi, Alberto Briganti, Milan, Italy

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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