Although active surveillance (AS) is recommended for low- to favorable intermediate-risk prostate cancer (PCa), risk of upgrading at radical prostatectomy (RP) is not negligible. Available studies based on systematic transrectal ultrasound biopsy might not be applicable to contemporary cohorts diagnosed with MRI-targeted biopsy (TB). The aim of the present study is to explore rates and risk factors for adverse outcomes (AO) at RP in patients with ISUP ≤ 2 PCa detected at TB with concomitant systematic biopsy (SB).
Multicenter, retrospective analysis of 475 consecutive patients with ISUP ≤ 2 PCa at MRI-TB + SB is treated with RP. AO were defined as ISUP upgrading, adverse pathology (upgrading to ISUP ≥ 3 and/or ≥ pT3 at RP, and/or pN1) (AP) or biochemical recurrence (BCR) in men with follow-up (n = 327).
The rate of ISUP upgrading, upgrading ≥ 3, and AP were 39%, 21%, and 43%. Compared to ISUP2, men with ISUP1 PCa had a higher rate of overall upgrading (27 vs. 67%, p < 0.001), but less upgrading to ≥ 3 (27 vs. 10%, p < 0.001). AP was more common when ISUP2 was detected with a combined MRI-TB + SB approach compared to considering TB (p = 0.02) or SB (p = 0.01) alone. PSA, PSA density, PI-RADS, ISUP at TB, overall biopsy ISUP and EAU classification were predictors of upgrading to ISUP ≥ 3 and AP. The 1 year BCR-free survival was 94% with no differences in BCR rates between subgroups.
Upgrading in ISUP ≤ 2 PCa remains prevalent even in men diagnosed in the MRI era. The use of MRI-TB with concomitant SB allows for the accurate identification of ISUP2 PCa and predicts the risk of AO at RP.
World journal of urology. 2022 Dec 19 [Epub ahead of print]
Claudia Kesch, Vlad Pantea, Timo Soeterik, Alessandro Marquis, Giulia la Bombarda, Allesandro Morlacco, Francesco Barletta, Jan Philipp Radtke, Christopher Darr, Felix Preisser, Fabio Zattoni, Giancarlo Marra, Roderik C N van den Bergh, Boris Hadaschik, Giorgio Gandaglia, EAU-YAU Prostate Cancer Working Party
Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. ., Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany., Department of Urology, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands., Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy., Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padova, Padua, Italy., Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.