AUA 2018: Association of Systematic Biopsy vs. Magnetic Resonance Imaging/Ultrasound Fusion Targeted Biopsy with Prostate Cancer Upstaging at Radical Prostatectomy

San Francisco, CA (UroToday.com)  Multiparametric prostate MRI (mpMRI) has clear utility for many aspects of prostate cancer diagnosis, staging, and preoperative planning. However, given that it is a relatively newly-adopted modality, little is known regarding how mpMRI might predict downstream outcomes for patients undergoing treatment for prostate cancer.

In particular, the authors aimed to understand if mpMRI characteristics can help predict cancer upstaging (>=T3a) at the time of radical prostatectomy. Nomograms and risk-tools are currently used to try and answer this question, but no tool has perfect test characteristics at this point.

They identified 95 men in this cohort, of whom 41% had significant upstaging at prostatectomy. Their multivariable model found that many of the expected adverse pathological and clinical features (high PSA, higher grade group, PIRADS 5 lesions) were significantly associated with cancer upstaging. Intriguingly, though, only systematic biopsies (not MRI-targeted fusion biopsies) demonstrated any predictive ability for upstaging. Systematic biopsies that had perineural invasion had a significantly increased risk for upstaging (OR 5.27). 

The authors conclude that systematic biopsies may therefore continue to be relevant for this patient population, and that we must use caution when transitioning to more MRI-targeted protocols. This is certainly interesting data, especially in light of the results of the recent randomized PRECISION trial, which avoided the use of systematic biopsies in patients with MRI lesions. As a field, we must continue to be cautious to not miss important information for the sake of minimizing biopsies.


Presented by: Kamyar Amirkhiz, MD; Yale School of Medicine
Co-Authors: Alfredo Suarez-Sarmiento, Kevin A. Nguyen, Walter Hsiang, Sarah Amalraj, Jamil S. Syed, Michael S. Leapman, Peter G. Schulam, Preston C. Sprenkle, New Haven, CT

Written by:  Shreyas Joshi, MD, Fox Chase Cancer Center, Philadelphia, PA, @ssjoshimd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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