Sub-optimal Prediction of Clinically Significant Prostate Cancer in Radical Prostatectomy Specimens by mpMRI-Targeted Biopsy.

To investigate the correlation of multiparametric magnetic resonance imaging targeted (TBx) and/or systematic prostate biopsy (SBx) in predicting the presence of clinically significant (cs) prostate cancer (PCa) in radical prostatectomy (RP) specimens. Concordance of mpMRI and RP specimen lesions was also investigated in terms of tumor localization and histopathological features.

A total of 70 male patients with PCa and treated with robot-assisted radical prostatectomy were included in this study between January 2016 and December 2019. All patients underwent mpMRI-TBx and concomitant SBx. Suspicious lesions on mpMRI were scored according to Prostate Imaging-Reporting and Data System version 2 (PI-RADS) criteria. TBx was performed for all suspicious lesions with a PI-RADS score ≥3.

The median age was 67 (43 - 77) years. Presence of csPCa in prostatectomy specimens was missed by TBx and SBx specimens in 25.4% and 19.4% of the cases, respectively (p<0.001, for each). Combination of both biopsy (CBx) results improved detection by missing only 4.5% of csPCa (p=0.250). International Society of Urologic Pathology grade group concordance with RP specimens were 50%, 54.3% and 67.1% for SBx, TBx and CBx, respectively. There was a statistically significant correlation in terms of tumor localization and histopathological features between prostatectomy specimens and the first 3 lesions, particularly for the index lesions.

CBx improved detection rate of csPCa. We propose TBx of 3 lesions with highest PI-RADS score(s) and a combination with SBx for the highest correlation with prostatectomy histopathology.

Urology. 2020 Aug 29 [Epub ahead of print]

Nejdet Karsiyakali, Mahir Bulent Ozgen, Bora Ozveren, Cem Akbal, Alp Dincer, Haydar Durak, Levent Turkeri

Department of Urology, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey. Electronic address: ., Department of Urology, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey., Department of Urology, Acibadem M.A. Aydinlar University, School of Medicine, Altunizade Hospital, Istanbul, Turkey., Department of Radiology, Acibadem M.A. Aydinlar University, School of Medicine, Altunizade Hospital, Istanbul, Turkey., Clinical Pathology Laboratory, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey.