In this manuscript, we compared the histopathologic concordance with radical prostatectomy between systematic (SB), targeted (TB) biopsies (MRI/US image fusion using Koelis® device) and the combination of both (systematic and targeted biopsies together, SB + TB). We analyzed 443 patients who underwent radical prostatectomy after systematic and targeted biopsies. For ISUP grade group ≥ 2 (Gleason score ≥ 7 (3+4)) at surgery, a significant difference was found between SB group and SB + TB group for upgrading, downgrading and concordance (p < 0.001), between TB group and SB + TB group (p < 0.001), between SB group and TB group (only for upgrading and concordance, p < 0.001). A post hoc subgroup analysis including only biopsy-naïve patients showed similar results (Figure 1a-b-c). Finally, multivariable analysis revealed that previous biopsy (OR = 0.6, 95% CI (0.4 – 0.9) p = 0.01) and number of cores taken (OR = 1.2, 95% CI (1.1 – 1.3) p = 0.004) were independently associated with histopathological concordance.
Figure 1a. Histopathological concordance with the final specimen, overall ISUP grade.
Figure 1b. Histopathological concordance with the final specimen, ISUP ≥ 2.
Figure 1c. Histopathological concordance with the final specimen, ISUP ≥ 2 (biopsy-naïve patients).
To conclude, our data are in line with current literature and emphasize the importance of targeted biopsies. MRI/US image fusion and systematic biopsies were found to be complementary, significantly increasing concordance with final histopathology and causing a significant decrease in disease upgrading. Combining these two techniques may aid in tailoring the adequate treatment for each patient. In concordance with the results of the PRECISION, MRIfirst and 4M studies, we believe in the necessity of performing targeted biopsies to be able to evaluate tumors more accurately.
Written by: Romain Diamand, MD, Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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