MADRID, SPAIN (UroToday.com) - This group out of Germany addressed the issue of whether MR-guided prostate biopsy (MR-GB) reduces the risk of Gleason upgrading on radical prostatectomy as compared to transrectal ultrasound-guided prostate biopsy (TRUS-GB).
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Seventy-seven consecutive patients with radical prostatectomy (RP) who received multiparametric MRI of the prostate and subsequently underwent MR-GB were included in this cohort. Of these, 52 had an additional TRUS-GB during the same biopsy session. The primary endpoint of the study was to compare the rate of Gleason upgrading on MR-GB, TRUS-GB, and the combination of both biopsy modalities. Gleason grading was measured by two different methods: the conventional Gleason score and the highest Gleason pattern.
The median age of the patients was 68 (63-71), and the median serum PSA was 9.2 ng/ml (7.1-15.5). The positivity rate for prostate cancer was 60.8% and 30.3% for MR-GB and TRUS-GB cores, respectively. Positive MR-GB cores showed significantly higher tumor involvement (mean 47.7%) as compared to the positive TRUS-GB cores (mean 38.2%) (p < 0.01). In comparison to TRUS-GB, MR-GB alone showed lower rates of upgrading when comparing the conventional Gleason score (36.4 vs 50.0%) and the highest Gleason pattern (15.6% vs 32.7%). The difference between TRUS-GB and MR-GB was only significant when considering the highest Gleason pattern (odds ratio (OR) =0.38; 95%CI 0.16-0.89). The combination of MR-GB and TRUS-GB showed the lowest rates of upgrading (conventional Gleason score: 28.8%; highest Gleason-pattern: 11.5%) compared to TRUS-GB alone (conventional Gleason score: 50%; highest Gleason-pattern 32.7%).
The group concluded that multiparametric prostate MRI and MR-GB are useful tools that better characterize and stage the extent of disease. As compared to TRUS-GB, MR-GB increases the detection rate of higher Gleason-pattern cancer at the same rate as decreasing the upstaging rate. The combination of MR-GB and TRUS-GB presents the least risk of Gleason upstaging.
Presented by Arsov C.,1 Becker N.,2 Hiester A.,1 Schimmöller L.,3 Quentin M.,3 Dietzel F.,3 Gabbert H.,4 Antoch G.,3 Albers P.,1 and Rabenalt R.1 at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain
1University Hospital Düsseldorf, Dept. of Urology, Düsseldorf, 2German Cancer Research Center Heidelberg, Division of Cancer Epidemiology, Heidelberg, 3University Hospital Düsseldorf, Dept. of Diagnostic and Interventional Radiology, Düsseldorf, 4University Hospital Düsseldorf, Dept. of Pathology, Düsseldorf
Reported by Mohammed Haseebuddin, MD, medical writer for UroToday.com