PURPOSE - Magnetic resonance imaging (MRI) guidance may improve the accuracy of Gleason score (GS) determination by directing the biopsy to regions of interest (ROI) that are likely to harbor high-grade prostate cancer (CaP). The aim of this study was to determine the frequency and predictors of GS upgrading when a subsequent MRI-guided biopsy is performed on patients with a diagnosis of GS 6 disease on the basis of conventional, transrectal ultrasound-guided biopsy.
MATERIALS AND METHODS - A consecutive series of 245 men with a diagnosis of low-risk CaP (ie, cT1c, GS 6, prostate-specific antigen <10) based on transrectal ultrasound-guided biopsy was enrolled in an active surveillance protocol that used subsequent MRI-guided biopsy for confirmation of GS. ROIs were categorized on a scale of 1 to 5. The Artemis ultrasound-MRI fusion device was used to perform targeted biopsies of ROIs as well as systematic biopsies from a software-based 12-point map. Predictors of GS upgrading were analyzed using univariate and multivariate analyses.
RESULTS - Fusion biopsy resulted in 26% of patients having GS upgrading (GS 3+4 in 18%, 4+3 in 5%, and 8-9 in 3%). Of the 72% of patients with ROIs appropriate for targeting, targeted cores upgraded the GS in 18%, whereas systematic cores upgraded the GS in 24%. In patients without targeted biopsy, GS upgrading was seen in 14%. On multivariate analysis, a category 5 ROI was the most significant predictor of GS upgrading with an odds ratio of 10.56 (P < .01).
CONCLUSIONS - Nearly 25% of men with GS 6 CaP diagnosed by standard transrectal ultrasound biopsy may experience GS upgrading when a subsequent MRI-ultrasound fusion biopsy is performed. The most important single predictor of upgrading is a category 5 ROI on multiparametric MRI. GS upgrading may influence treatment decisions. Therefore, MRI-guided biopsy should be considered prior to formulating a management strategy in patients whose conventional biopsy reveals low-risk CaP.
Pract Radiat Oncol. 2015 Jun 6. pii: S1879-8500(15)00154-X. doi: 10.1016/j.prro.2015.04.006. [Epub ahead of print]
Kamrava M1, Kishan AU2, Margolis DJ3, Huang J4, Dorey F5, Lieu P5, Kupelian PA2, Marks LS5.
1 Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
2 Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
3 Department of Radiology, University of California Los Angeles, Los Angeles, California.
4 Department of Pathology, University of California Los Angeles, Los Angeles, California.
5 Department of Urology, University of California Los Angeles, Los Angeles, California.