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Performance of systematic, MRI-targeted biopsies alone or in combination for the prediction of unfavourable disease in MRI-positive low-risk prostate cancer patients eligible for active surveillance

  • Guillaume PloussardEmail author
  • Jean-Baptiste Beauval
  • Marine Lesourd
  • Christophe Almeras
  • Jacques Assoun
  • Richard Aziza
  • Jean-Romain Gautier
  • Guillaume Loison
  • Daniel Portalez
  • Ambroise Salin
  • Christophe Tollon
  • Michel Soulié
  • Bernard Malavaud
  • Mathieu Roumiguié
Original Article

Abstract

Purpose

To assess the upstaging/upgrading rates of low-risk prostate cancer (PCa) according to the biopsy scheme used (systematic (SB), targeted biopsies (TB), or both) in the setting of positive pre-biopsy MRI.

Patients and methods

We included 143 consecutive men fulfilling the Toronto University active surveillance (AS) criteria who underwent a pre-biopsy positive MRI, a combination of SB and software-based fusion TB, and a radical prostatectomy, in two expert centres. The primary endpoints were the pathological upgrading and upstaging rates. Overall unfavourable disease (OUD) was defined by any pT3-4 and/or pN1 and/or ≥ GG 3.

Results

Using TB alone would have missed 21.7% of cancers including 16.7% of ≥ GG 3. The use of TB was significantly associated with a lower risk of ≥ Grade Group (GG) 3 disease (p < 0.006) in RP specimens. Combination of SB and TB lowered this risk by 39%, compared with TB alone. The biopsy scheme did not affect the upstaging rates which were substantial even in case of combination scheme (from 37 to 46%). OUD was detected in approximately 50% of cases. The presence of high grade on TB was the only independent predictive factor for both ≥ GG 2 (p = 0.015) and ≥ GG 3 (p = 0.023) in RP specimens.

Conclusions

High grade on TB biopsies represented the major predictor of upgrading. Combination of SB and TB better defined the sub-group of patients having the lowest risk of reclassification, compared with TB or SB alone. The risk of non-organ-confined disease remained high, and could not be accurately predicted by MRI or systematic/targeted biopsy features.

Keywords

Prostate cancer Radical prostatectomy Active surveillance Low risk Biopsy Targeted biopsies, MRI Fusion biopsies 

Notes

Author contributions

Protocol/project development: GP, BM and MR. Data collection or management: GP, J-BB, ML, CA, JA, RA, J-R G, GL, DP, AS, CT, MS, BM and MR. Data analysis: GP and MR. Manuscript writing/editing: GP, BM and MR.

Compliance with ethical standards

Conflicts of interest

The authors declares that they have no competing interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards.

Informed consent

Informed consent was systematically obtained from each participant.

References

  1. 1.
    Mottet N, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:618–629CrossRefGoogle Scholar
  2. 2.
    Klotz L, Vesprini D, Sethukavalan P et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33:272–277CrossRefGoogle Scholar
  3. 3.
    Bokhorst LP, Valdagni R, Rannikko A, PRIAS study group et al (2016) A Decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment. Eur Urol 70:954–960CrossRefGoogle Scholar
  4. 4.
    Welty CJ, Cowan JE, Nguyen H et al (2015) Extended followup and risk factors for disease reclassification in a large active surveillance cohort for localized prostate cancer. J Urol 193(3):807–811CrossRefGoogle Scholar
  5. 5.
    Hu JC, Chang E, Natarajan S et al (2014) Targeted prostate biopsy in select men for active surveillance: do the Epstein criteria still apply? J Urol 192:385–390CrossRefGoogle Scholar
  6. 6.
    Schoots IG, Petrides N, Giganti F et al (2015) Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol 67:627–636CrossRefGoogle Scholar
  7. 7.
    Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777CrossRefGoogle Scholar
  8. 8.
    Siddiqui MM, George AK, Rubin R et al (2016) Efficiency of prostate cancer diagnosis by MR/ultrasound fusion-guided biopsy vs standard extended-sextant biopsy for MR-visible lesions. J Natl Cancer Inst.  https://doi.org/10.1093/jnci/djw039 Google Scholar
  9. 9.
    Covin B, Roumiguié M, Quintyn-Ranty ML et al (2018) Refining the risk-stratification of transrectal biopsy-detected prostate cancer by elastic fusion registration transperineal biopsies. World J Urol.  https://doi.org/10.1007/s00345-018-2459-4 Google Scholar
  10. 10.
    Klotz L, Loblaw A, Sugar L et al (2018) Active surveillance magnetic resonance imaging study (ASIST): results of a randomized multicenter prospective trial. Eur Urol.  https://doi.org/10.1016/j.eururo.2018.06.025 Google Scholar
  11. 11.
    Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757CrossRefGoogle Scholar
  12. 12.
    Barentsz JO, Weinreb JC, Verma S et al (2016) Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol 69:41–49CrossRefGoogle Scholar
  13. 13.
    Nakanishi H, Wang X, Ochiai A, Trpkov K, Yilmaz A, Donnelly JB, Davis JW, Troncoso P, Babaian RJ (2007) A nomogram for predicting low-volume/low-grade prostate cancer: a tool in selecting patients for active surveillance. Cancer 110(11):2441–2447CrossRefGoogle Scholar
  14. 14.
    Steyerberg EW, Roobol MJ, Kattan MW, van der Kwast TH, de Koning HJ, Schröder FH (2007) Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram. J Urol 177(1):107–112CrossRefGoogle Scholar
  15. 15.
    Ochiai A, Trpkov K, Yilmaz A, Donnelly B, Babaian RJ (2007) Validation of a prediction model for low volume/low grade cancer: application in selecting patients for active surveillance. J Urol 177(3):907–910CrossRefGoogle Scholar
  16. 16.
    Gandaglia G, van den Bergh RCN, Tilki D et al (2018) How can we expand active surveillance criteria in patients with low- and intermediate-risk prostate cancer without increasing the risk of misclassification? Development of a novel risk calculator. BJU Int 122:823–830CrossRefGoogle Scholar
  17. 17.
    Capitanio U, Karakiewicz PI, Valiquette L et al (2009) Biopsy core number represents one of foremost predictors of clinically significant Gleason sum upgrading in patients with low-risk prostate cancer. Urology 73:1087–1091CrossRefGoogle Scholar
  18. 18.
    Turley RS, Terris MK, Kane CJ et al (2008) The association between prostate size and Gleason score upgrading depends on the number of biopsy cores obtained: results from the Shared Equal Access Regional Cancer Hospital Database. BJU Int 102:1074–1079CrossRefGoogle Scholar
  19. 19.
    Ahmed HU, El-Shater Bosaily A, Brown LC et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822CrossRefGoogle Scholar
  20. 20.
    Fütterer JJ, Briganti A, De Visschere P et al (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 68:1045–1053CrossRefGoogle Scholar
  21. 21.
    Briganti A, Fossati N, Catto JWF et al (2018) Active surveillance for low-risk prostate cancer: the European Association of Urology Position in 2018. Eur Urol 74:357–368CrossRefGoogle Scholar
  22. 22.
    Margel D, Yap SA, Lawrentschuk N et al (2012) Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: a prospective cohort study. J Urol 187:1247–1252CrossRefGoogle Scholar
  23. 23.
    Ploussard G, Borgmann H, Briganti A et al (2018) Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies? World J Urol.  https://doi.org/10.1007/s00345-018-2399 Google Scholar
  24. 24.
    Gold SA, Hale GR, Bloom JB et al (2018) Follow-up of negative MRI-targeted prostate biopsies: when are we missing cancer? World J Urol.  https://doi.org/10.1007/s00345-018-2337-0 Google Scholar
  25. 25.
    Westhoff N, Siegel FP, Hausmann D et al (2017) Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms. World J Urol 35:1015–1022CrossRefGoogle Scholar
  26. 26.
    Schouten MG, van der Leest M, Pokorny M et al (2017) Why and where do we miss significant prostate cancer with multi-parametric magnetic resonance imaging followed by magnetic resonance-guided and transrectal ultrasound-guided biopsy in Biopsy-naïve Men? Eur Urol 71:896–903CrossRefGoogle Scholar
  27. 27.
    Musunuru HB, Yamamoto T, Klotz L et al (2016) Active surveillance for intermediate risk prostate cancer: survival outcomes in the sunnybrook experience. J Urol 196:1651–1658CrossRefGoogle Scholar
  28. 28.
    van den Bergh R, Gandaglia G, Tilki D et al (2019) Trends in radical prostatectomy risk group distribution in a European multicenter analysis of 28 572 patients: towards tailored treatment. Eur Urol Focus 5:171–178CrossRefGoogle Scholar
  29. 29.
    Elkhoury FF, Simopoulos DN, Marks LS (2018) Targeted prostate biopsy in the era of active surveillance. Urology 112:12–19CrossRefGoogle Scholar
  30. 30.
    Cornud F, Roumiguié M, de Longchamps BN et al (2018) Precision matters in mr imaging-targeted prostate biopsies: evidence from a prospective study of cognitive and elastic fusion registration transrectal biopsies. Radiology 287:534–542CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Guillaume Ploussard
    • 1
    • 2
    Email author
  • Jean-Baptiste Beauval
    • 3
  • Marine Lesourd
    • 2
    • 3
  • Christophe Almeras
    • 1
  • Jacques Assoun
    • 4
  • Richard Aziza
    • 5
  • Jean-Romain Gautier
    • 1
  • Guillaume Loison
    • 1
  • Daniel Portalez
    • 5
  • Ambroise Salin
    • 1
  • Christophe Tollon
    • 1
  • Michel Soulié
    • 3
  • Bernard Malavaud
    • 2
    • 3
  • Mathieu Roumiguié
    • 2
    • 3
  1. 1.Department of UrologyLa Croix du Sud Hospital, IUCT-O, ToulouseQuint FonsegrivesFrance
  2. 2.Department of UrologyInstitut Universitaire du Cancer Toulouse, OncopoleToulouseFrance
  3. 3.Department of UrologyCHU ToulouseToulouseFrance
  4. 4.Department of RadiologyLa Croix du Sud HospitalQuint FonsegrivesFrance
  5. 5.Department of RadiologyInstitut Universitaire du Cancer Toulouse-OncopoleToulouseFrance

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