ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2020 June;72(3):360-8

DOI: 10.23736/S0393-2249.19.03367-8

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Risk of Gleason Score 3+4=7 prostate cancer upgrading at radical prostatectomy is significantly reduced by targeted versus standard biopsy

Stefano DE LUCA ¹, Cristian FIORI ¹, Enrico BOLLITO ², Diletta GARROU ¹, Roberta AIMAR ¹, Giovanni CATTANEO ¹, Sabrina DE CILLIS ¹, Matteo MANFREDI ¹, Daniele TOTA ², Massa FEDERICA ², Roberto PASSERA ³, Francesco PORPIGLIA ¹ ✉

¹ Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; ² Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; ³ Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy

BACKGROUND: The aim of this study is to evaluate if multiparametric magnetic resonance (mpMRI)-transrectal ultrasound (TRUS) fusion targeted biopsy (TBx) versus untargeted standard biopsy (SBx) may decrease the rate of pathological upgrading of Gleason Score (GS) 3+4 prostate cancer (PCa) at radical prostatectomy (RP). We also evaluated the impact of percent pattern 4 and cribriform glands at biopsy in the risk of GS 3+4=7 upgrading.
METHODS: A total of 301 patients with GS 3+4 PCa on biopsy (159 SBx and 142 TBx) who underwent laparoscopic robot-assisted RP were sequentially enrolled. Histological data from RP sections were used as reference standard. The concordance of biopsy with pathological GS, as well as the GS 3+4 upgrading at RP were evaluated in different univariate and multivariate binary logistic regression models, testing age, PSA, fPSA%, tumor volume, PI-RADS, clinical stage, percentage of Gleason pattern 4 (GP) and/or presence of cribriform sub-type at biopsy.
RESULTS: Of the 301 biopsies, the median of GP 4 was 16% of the tissue. Minimal GP 4 (≤16%) cancers had a significant lower median volume (1.7 mL) than those with GP4 >16% (2.9 mL), (P<0.001). Pathological GS 3+4 was confirmed for 58.8% and 82.2% for SBx and TBx patients, respectively. The rate of upgraded and downgraded GS on SBx versus TBx was 38.8% vis. 16.7% and 1.8% and 2.1%, respectively. The rate of upgrading was significantly associated with the presence of GP4 >16% versus ≤16% (OR 4.4, 95% CI 1.4-12.0; P=0.021) and with the presence of cribriform sub-type at biopsy specimens (OR 6.2, 95% CI 2.2-18.7; P<0.001).
CONCLUSIONS: We demonstrated that TBx technique significantly reduced the risk of GS 3+4 upgrading at RP, compared to SBx one. The rate of upgrading was significantly associated with GP4>16%, mostly when cribriform sub-type was present at biopsy specimens.

KEY WORDS: Prostatic neoplasms; Magnetic resonance imaging; Biopsy; Prostatectomy; Neoplasm grading