Added value of concomitant systematic biopsies for grade group prediction based on radical prostatectomy final pathology in MRI-positive patients undergoing fusion targeted biopsies.

To assess the added value of concomitant systematic biopsies (SB) for final grade group prediction in MRI positive patients undergoing targeted biopsies (TB).

We included 478 consecutive patients had a pre-biopsy positive mpMRI, a >10-core SB combined with fusion TB, and a RP. The primary endpoint was the grade group concordance between biopsy and RP pathology, according to the biopsy technique. Clinical and biological factors associated with the performance of SB were analysed.

Adding SB to TB modified the d'Amico risk classification towards more intermediate/high risk cases in 7.8% of cases, mainly from low to intermediate risk (44.3% of low risk PCa on TB). This reclassification was significantly higher in patients having with lower PSA and a PSAD <0.20 ng/ml/gr (11.7% versus 2.4%; p<0.001). Concordance rate between biopsy and RP pathology was significantly different between TB (45.2%) and TB + SB (51.7%). Upgrading rate in RP specimens decreased by 22% when adding SB to TB. Patients for whom SB did not modify grading were more likely to have a pT3-4 and/or pN1 disease on final pathology (56.9% versus 38.3%, p=0.007).

Grading concordance between biopsy and RP pathology was improved by the addition of SB in all sub-groups of patients. Patients having a PSAD <0.20 ng/ml/gr benefited the most from this combined biopsy strategy. SB reclassified patients towards higher risk category in a not negligible proportion of cases, mainly the low risk ones, and thereby, could modify the treatment decision-making.

The Journal of urology. 2019 Jun 27 [Epub ahead of print]

Guillaume Ploussard, Jean-Baptiste Beauval, Marine Lesourd, Christophe Almeras, Jacques Assoun, Richard Aziza, Jean-Romain Gautier, Guillaume Loison, Daniel Portalez, Ambroise Salin, Christophe Tollon, Michel Soulié, Bernard Malavaud, Mathieu Roumiguié

Department of Urology, La Croix du Sud Hospital , Quint Fonsegrives , France., Department of Urology, Institut Universitaire du Cancer Toulouse - Oncopole , Toulouse , France., Department of Radiology, La Croix du Sud Hospital , Quint Fonsegrives , France., Department of Radiology, Institut Universitaire du Cancer Toulouse - Oncopole , Toulouse , France., Department of Urology, CHU Toulouse , Toulouse , France.

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