Comparison of TRUS and Combined MRI Targeted plus Systematic Prostate
Biopsy for the Concordance Between Biopsy and Radical Prostatectomy
Pathology
Abstract
Aim: To evaluate the accuracy in histologic grading of MRI/US image
fusion biopsy by comparing conventional 12-core TRUS-Bx at radical
prostatectomy specimens (RP). Methods: Consecutive patients diagnosed
prostate cancer (127 with combination of both targeted biopsy (TBx) plus
systematic biopsies (SBx) and separate patient cohort of 330
conventional TRUS-Bx without mpMRI) with a PSA level of <20
ng/ml prior to RP were included. The primary end point was the grade
group concordance between biopsy and RP pathology according to biopsy
technique. Results: Clinically significant prostate cancer detection was
51.2 % for TRUS-Bx, 49.5 % for SBx, 67% for TBx and 75.7% for
TBx+SBx . Upgrading and downgrading of at least one Gleason Grade Group
(GGG) was recorded in 43.3% / 6.7% patients of the TRUS-Bx, and in
20.5% / 22 % of the TBX+SBx group, respectively (all
p<0.001). Concordance level was detected to be significantly
higher for ISUP 1 in combined TBx + SBx method compared to conventional
TRUS-Bx (61.3% vs 37.9%, p=0.014). In ISUP 1 exclusively, significant
upgrading was seen in TRUS-Bx (62.1%) when compared to TBx (41.4%) and
TBx+SBx (38.7%). Conclusions: MRI-targeted biopsies detected more
significant PCa than TRUS-Bx but, superiority in significant cancer
detection appears as a result of inadvertant selective sampling of small
higher grade areas. within an otherwise low grade cancer and does not
reflect accurate GGG final surgical pathology. TBx+SBx has the greatest
concordance in ISUP Grade 1 with less upgrading which is utmost
important for active surveillance.