To assess the proportion and risk factors for downgrading and reclassification to favorable disease in patients having high-grade (HG) prostate cancer (PCa) pattern on magnetic resonance imaging (MRI)-targeted-biopsy (TB).
From a radical prostatectomy (RP) cohort, we included patients with pre-biopsy positive MRI and HG [defined by Grade Group (GG) ≥ 3] PCa on MRI-TB. All patients also underwent concomitant systematic biopsy (SB). The main endpoints were the rates of downgrading to GG2, overall downgrading, favorable disease (pT2 and GG2) on RP specimens, and biochemical recurrence-free-survival (RFS). We studied the correlations between HG on concomitant SB, final pathological outcomes and biochemical RFS curves.
Overall downgrading, downgrading to GG2 disease and favorable disease were noted in 36.2%, 24.1%, and 15.4% respectively. HG on concomitant SB was correlated with pT3-4 disease (p < 0.001), pN1 disease (p < 0.001), positive surgical margins (p = 0.043), PSA recurrence (p = 0.003). In multivariable analysis, the presence of GG4-5 on TB (p = 0.013; OR 0.263) and the presence of HG on concomitant SB (p = 0.010; OR 0.269) were negatively and independently correlated with the risk of downgrading to GG2. The presence of HG on concomitant SB independently predicted RFS with a hazard ratio of 2.173 (p = 0.049; 95% CI 1.005–4.697).
Our data shows that a limited HG restricted to TB can often be associated with a favorable grade in almost a quarter of the cases and downgraded in almost half of the cases. Detailed SB features, mainly the presence of HG on concomitant SB, was associated with a more accurate pathology and oncologic outcomes prediction, pleading for the maintenance of SB in MRI-positive patients.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Extraprostatic extension (EPE)
Magnetic resonance imaging
Prostate Imaging-Reporting and Data System
Siddiqui MM, Rais-Bahrami S, Truong H et al (2013) Magnetic resonance imaging/ultrasound–fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 64:713–719. https://doi.org/10.1016/j.eururo.2013.05.059
Goel S, Shoag JE, Gross MD et al (2020) Concordance between biopsy and radical prostatectomy pathology in the era of targeted biopsy: a systematic review and meta-analysis. Eur Urol Oncol 3:10–20. https://doi.org/10.1016/j.euo.2019.08.001
Ploussard G, Beauval J-B, Lesourd M et al (2019) Added value of concomitant systematic and fusion targeted biopsies for grade group prediction based on radical prostatectomy final pathology on positive magnetic resonance imaging. J Urol 202:1182–1187. https://doi.org/10.1097/JU.0000000000000418
Diamand R, Oderda M, Al Hajj Obeid W et al (2019) A multicentric study on accurate grading of prostate cancer with systematic and MRI/US fusion targeted biopsies: comparison with final histopathology after radical prostatectomy. World J Urol. https://doi.org/10.1007/s00345-019-02634-9
Beksac AT, Sobotka S, Xu P et al (2019) Downgrading of grade group after radical prostatectomy: comparison of multiparametric magnetic resonance imaging guided fusion biopsy and standard 12-core biopsy. Urology 127:80–85. https://doi.org/10.1016/j.urology.2019.02.001
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 108:djw039. https://doi.org/10.1093/jnci/djw039
Ploussard G, Beauval JB, Lesourd M et al (2019) Added value of concomitant systematic biopsies for grade group prediction based on radical prostatectomy final pathology in MRI-positive patients undergoing fusion targeted biopsies. J Urol 202:1182–1187
Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777. https://doi.org/10.1056/NEJMoa1801993
van der Leest M, Cornel E, Israël B et al (2019) Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 75:570–578. https://doi.org/10.1016/j.eururo.2018.11.023
Rouvière O, Puech P, Renard-Penna R et al (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 20:100–109. https://doi.org/10.1016/S1470-2045(18)30569-2
Brimo F, Xu B, Scarlata E et al (2014) Biopsy characteristics in men with a preoperative diagnosis of prostatic adenocarcinoma with high Gleason score (8–10) predict pathologic outcome in radical prostatectomy. Hum Pathol 45:2006–2013. https://doi.org/10.1016/j.humpath.2014.06.014
Ginsburg K, Cole AI, Silverman ME et al (2020) Should all prostate needle biopsy Gleason score 4 + 4 = 8 prostate cancers be high risk? Implications for shared decision-making and patient counselling. Urol Oncol Semin Orig Investig 38:78.e1-78.e6. https://doi.org/10.1016/j.urolonc.2019.11.002
Epstein JI, Feng Z, Trock BJ, Pierorazio PM (2012) Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol 61:1019–1024. https://doi.org/10.1016/j.eururo.2012.01.050
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 69:41–49. https://doi.org/10.1016/j.eururo.2015.08.038
Stabile A, Dell’Oglio P, Gandaglia G et al (2018) Not all multiparametric magnetic resonance imaging–targeted biopsies are equal: the impact of the type of approach and operator expertise on the detection of clinically significant prostate cancer. Eur Urol Oncol 1:120–128. https://doi.org/10.1016/j.euo.2018.02.002
Epstein JI, Amin MB, Reuter VE, Humphrey PA (2017) Contemporary Gleason grading of prostatic carcinoma: an update with discussion on practical issues to implement the 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 41:e1–e7. https://doi.org/10.1097/PAS.0000000000000820
The ISUP Prostate Cancer Group, Samaratunga H, Montironi R et al (2011) International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Working group 1: specimen handling. Mod Pathol 24:6–15. https://doi.org/10.1038/modpathol.2010.178
Schreiber D, Wong AT, Rineer J et al (2015) Prostate biopsy concordance in a large population-based sample: a surveillance, epidemiology and end results study. J Clin Pathol 68:453–457. https://doi.org/10.1136/jclinpath-2014-202767
Goldberg H, Ahmad AE, Chandrasekar T et al (2020) Comparison of magnetic resonance imaging and transrectal ultrasound informed prostate biopsy for prostate cancer diagnosis in biopsy Naïve men: a systematic review and meta-analysis. J Urol 203:1085–1093. https://doi.org/10.1097/JU.0000000000000595
Ploussard G, Manceau C, Beauval J-B et al (2019) Decreased accuracy of the prostate cancer EAU risk group classification in the era of imaging-guided diagnostic pathway: proposal for a new classification based on MRI-targeted biopsies and early oncologic outcomes after surgery. World J Urol. https://doi.org/10.1007/s00345-019-03053-6
Reed A, Valle LF, Shankavaram U et al (2017) Effect of prostate magnetic resonance imaging/ultrasound fusion-guided biopsy on radiation treatment recommendations. Int J Radiat Oncol 97:947–951. https://doi.org/10.1016/j.ijrobp.2016.12.016
Dix DB, McDonald AM, Gordetsky JB et al (2018) How would MRI-targeted prostate biopsy alter radiation therapy approaches in treating prostate cancer? Urology 122:139–146. https://doi.org/10.1016/j.urology.2018.08.027
Epstein JI, Zelefsky MJ, Sjoberg DD et al (2016) A contemporary prostate cancer grading system: a validated alternative to the Gleason Score. Eur Urol 69:428–435. https://doi.org/10.1016/j.eururo.2015.06.046
Pierorazio PM, Walsh PC, Partin AW, Epstein JI (2013) Prognostic Gleason grade grouping: data based on the modified Gleason scoring system: prognostic Gleason grade grouping. BJU Int 111:753–760. https://doi.org/10.1111/j.1464-410X.2012.11611.x
Vickers A, Carlsson SV, Cooperberg M (2020) Routine use of magnetic resonance imaging for early detection of prostate cancer is not justified by the clinical trial evidence. Eur Urol. https://doi.org/10.1016/j.eururo.2020.04.016
Kweldam CF, Wildhagen MF, Steyerberg EW et al (2015) Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer. Mod Pathol 28:457–464. https://doi.org/10.1038/modpathol.2014.116
Flood TA, Schieda N, Keefe DT et al (2016) Utility of Gleason pattern 4 morphologies detected on transrectal ultrasound (TRUS)-guided biopsies for prediction of upgrading or upstaging in Gleason score 3 + 4 = 7 prostate cancer. Virch Arch 469:313–319. https://doi.org/10.1007/s00428-016-1981-2
No financial disclosure.
Conflict of interest
The authors declare that there are no conflicts of interest.
Consent to participate
Informed consent was obtained.
Consent for publication
Informed consent was obtained.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Manceau, C., Fromont-Hankard, G., Beauval, JB. et al. The prognostic value of high-grade prostate cancer pattern on MRI-targeted biopsies: predictors for downgrading and importance of concomitant systematic biopsies. World J Urol (2021). https://doi.org/10.1007/s00345-021-03631-7
- Prostate cancer
- Radical prostatectomy
- Targeted biopsy
- Systematic biopsy