US lesion visibility predicts clinically significant upgrade of prostate cancer by systematic biopsy.

To identify predictors of when systematic biopsy leads to a higher overall prostate cancer grade compared to targeted biopsy.

918 consecutive patients who underwent prostate MRI followed by MRI/US fusion biopsy and systematic biopsies from January 2015 to November 2019 at a single academic medical center were retrospectively identified. The outcome was upgrade of PCa by systematic biopsy, defined as cases when systematic biopsy led to a Gleason Grade (GG) ≥ 2 and greater than the maximum GG detected by targeted biopsy. Generalized linear regression and conditional logistic regression were used to analyze predictors of upgrade.

At the gland level, the presence of an US-visible lesion was associated with decreased upgrade (OR 0.64, 95% CI 0.44-0.93, p = 0.02). At the sextant level, upgrade was more likely to occur through the biopsy of sextants with MRI-visible lesions (OR 2.58, 95% CI 1.87-3.63, p < 0.001), US-visible lesions (OR 1.83, 95% CI 1.14-2.93, p = 0.01), and ipsilateral lesions (OR 3.89, 95% CI 2.36-6.42, p < 0.001).

Systematic biopsy is less valuable in patients with an US-visible lesion, and more likely to detect upgrades in sextants with imaging abnormalities. An approach that takes additional samples from regions with imaging abnormalities may provide analogous information to systematic biopsy.

Abdominal radiology (New York). 2022 Jan 07 [Epub ahead of print]

Nathan Velarde, Antonio C Westphalen, Hao G Nguyen, John Neuhaus, Katsuto Shinohara, Jeffry P Simko, Peder E Larson, Kirti Magudia

Department of Radiology, University of California, San Francisco, San Francisco, CA, USA. ., Department of Radiology, Urology, and Radiation Oncology, University of Washington, Seattle, WA, USA., Department of Urology, University of California, San Francisco, San Francisco, CA, USA., Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA., Department of Pathology, University of California, San Francisco, San Francisco, CA, USA., Department of Radiology, University of California, San Francisco, San Francisco, CA, USA., Department of Radiology, Duke University, Durham, NC, USA.

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