Pd26-12 Persistent Need for Systematic Biopsy for Those on Active Surveillance for Early-Stage Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD26)1 May 2024PD26-12 PERSISTENT NEED FOR SYSTEMATIC BIOPSY FOR THOSE ON ACTIVE SURVEILLANCE FOR EARLY-STAGE PROSTATE CANCER Mary Fakunle, Janet Cowan, Samuel Washington, Katsuto Shinohara, Hao Nguyen, Matthew Cooperberg, and Peter Carroll Mary FakunleMary Fakunle , Janet CowanJanet Cowan , Samuel WashingtonSamuel Washington , Katsuto ShinoharaKatsuto Shinohara , Hao NguyenHao Nguyen , Matthew CooperbergMatthew Cooperberg , and Peter CarrollPeter Carroll View All Author Informationhttps://doi.org/10.1097/01.JU.0001008556.20565.76.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Serial biopsy is a mainstay of monitoring for patients on active surveillance for prostate cancer. mpMRI targeting has become a standard for targeting lesions during biopsy as it allows for better identification of the dominant lesion (grade and/or volume). It is unclear whether "targeted biopsy" alone reliably identifies the dominant lesion on serial biopsy, thereby obviating the need for systematic biopsy. The aim of this study was to assess whether targeting alone can consistently identify the dominant lesion on serial biopsies for active surveillance. METHODS: Participants enrolled in active surveillance with early-stage prostate cancer (PSA<20, cT1-2, GG1) at diagnosis and underwent two or more targeted biopsy sessions that include both systematic and targeted sampling with MRI. Timing and frequency of Gleason upgrading were assessed. Grade and sextant location within the prostate were compared between the systematic and targeted cores to determine concordance. RESULTS: Among 1027 men who underwent MR fusion biopsies, 77% were diagnosed with GG 1 and 23% with GG 2. More than half (53%) of patients had their first MR fusion biopsy as their diagnostic or confirmatory biopsy. The dominant grade was found by MRI targeting on 77% of biopsies. Of those found by systematic biopsy, lesions were unique for 5% of cases and concordant with MRI targeted sites or Gleason grade for the remaining 95%. The unique findings comprised both a new site in the prostate and higher-grade disease outside the target. Findings were unique for men who underwent serial MR fusion biopsy with systematic sampling detecting high grade cancer and new location outside the target in 5% of biopsies. Most of the unique lesions detected outside the target had less aggressive features: 80% GG2 and 95% of GG2 or higher had <=20% pattern 4 and favorable histologic subtype. CONCLUSIONS: In men with MR-fusion biopsies, targeting alone identified the dominant tumor most of the time; 5% of men had higher grade disease outside the targeted lesion of which aggressive risk features were found in 20% or less. This suggests that men on active surveillance, with MR fusion targeting, still benefit from systematic biopsies. Source of Funding: Goldberg-Benioff Fund for Translational Cancer Biology © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e549 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mary Fakunle More articles by this author Janet Cowan More articles by this author Samuel Washington More articles by this author Katsuto Shinohara More articles by this author Hao Nguyen More articles by this author Matthew Cooperberg More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...