Mp74-13 Characterizing Clinically Significant Prostate Cancer Detected Only by Systematic Biopsy in an Mri-Targeted Biopsy Paradigm

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI (MP74), Moderated Poster 741 May 2024MP74-13 CHARACTERIZING CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTED ONLY BY SYSTEMATIC BIOPSY IN AN MRI-TARGETED BIOPSY PARADIGM Sean A. Fletcher, Mark N. Alshak, Yuezhou Jing, Nirmish Singla, Misop Han, Mohamad E. Allaf, and Christian P. Pavlovich Sean A. FletcherSean A. Fletcher , Mark N. AlshakMark N. Alshak , Yuezhou JingYuezhou Jing , Nirmish SinglaNirmish Singla , Misop HanMisop Han , Mohamad E. AllafMohamad E. Allaf , and Christian P. PavlovichChristian P. Pavlovich View All Author Informationhttps://doi.org/10.1097/01.JU.0001008632.59099.b9.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Performing routine systematic biopsies for all patients with targetable lesions on prostate MRI is controversial. Omitting systematic biopsy in these cases may reduce overdiagnosis of low grade tumors but risks missing occult high grade disease. We sought to characterize the prevalence and distribution of tumors found to be higher grade on systematic biopsy than on targeted biopsy. METHODS: We identified patients with a pre-biopsy MRI and a PI-RADS >3 lesion who underwent diagnostic systematic and targeted biopsy by one of four urologists at a high-volume center from 2021 to 2023. We compared the highest Gleason grade detected by systematic versus targeted biopsy for each patient. Clinically significant prostate cancer (csPCa) was defined as Gleason grade group 2 or higher. For those with higher grade csPCa detected on systematic compared to targeted biopsy, we correlated the pathologic location of the higher-grade systematic core to the corresponding MRI region(s) of interest (ROI). Multivariable logistic regression was used to determine factors associated with detecting higher grade csPCa on systematic biopsy; covariates included age, race, PSA density, clinical stage, PI-RADS score, and biopsy technique. RESULTS: Our final cohort consisted of 369 patients (Table 1). The overall detection rate of csPCa for PI-RADS 3, 4, and 5 lesions was 21%, 47%, and 69%, respectively. Detection of higher grade csPCa on systematic compared to targeted biopsy occurred in 12% of all biopsies. Of these cases, the systematic core detecting higher-grade csPCa was outside of the MRI ROI sextant in 60% and contralateral to the MRI ROI in 16%. Systematic biopsy detected csPCa when the targeted cores were benign in 20/369 cases (5%). There were no identifiable factors associated with detection of higher grade csPCa on systematic biopsy. CONCLUSIONS: Over one in ten patients with a visible MRI lesion have higher grade csPCa detected on systematic biopsy than on targeted biopsy. The majority of these higher-grade systematic cores are detected outside of the ROI sextant; one-sixth are contralateral to the ROI (therefore not attributable to targeting error). Our findings argue against routine omission of systematic biopsy for all patients with MRI lesions. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1198 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sean A. Fletcher More articles by this author Mark N. Alshak More articles by this author Yuezhou Jing More articles by this author Nirmish Singla More articles by this author Misop Han More articles by this author Mohamad E. Allaf More articles by this author Christian P. Pavlovich More articles by this author Expand All Advertisement PDF downloadLoading ...