Pd45-05 When Does Systematic Biopsy Information Matter the Most? Identifying Independent Predictors of Disease Downgrading at Radical Prostatectomy in High Grade Prostate Cancer Based on a Large Multi-Institutional Series

You have accessJournal of UrologyProstate Cancer: Staging II (PD45)1 May 2024PD45-05 WHEN DOES SYSTEMATIC BIOPSY INFORMATION MATTER THE MOST? IDENTIFYING INDEPENDENT PREDICTORS OF DISEASE DOWNGRADING AT RADICAL PROSTATECTOMY IN HIGH GRADE PROSTATE CANCER BASED ON A LARGE MULTI-INSTITUTIONAL SERIES Gabriele Sorce, Armando Stabile, Mattia Longoni, Pietro Scilipoti, Guillaume Ploussard, Giancarlo Marra, Massimo Valerio, Riccardo Campi, Andrea Minervini, Sergio Serni, Marco Moschini, Alessandro Marquis, Jean Baptiste Beauval, Arnas Rakauskas, Roderick van den Bergh, Razvan-George Rahota, Timo F. W. Soeterik, Mathieu Roumiguié, Hongqian Guo, Agostino Mattei, Paolo Gontero, Giorgio Gandaglia, Francesco Montorsi, and Alberto Briganti Gabriele SorceGabriele Sorce , Armando StabileArmando Stabile , Mattia LongoniMattia Longoni , Pietro ScilipotiPietro Scilipoti , Guillaume PloussardGuillaume Ploussard , Giancarlo MarraGiancarlo Marra , Massimo ValerioMassimo Valerio , Riccardo CampiRiccardo Campi , Andrea MinerviniAndrea Minervini , Sergio SerniSergio Serni , Marco MoschiniMarco Moschini , Alessandro MarquisAlessandro Marquis , Jean Baptiste BeauvalJean Baptiste Beauval , Arnas RakauskasArnas Rakauskas , Roderick van den BerghRoderick van den Bergh , Razvan-George RahotaRazvan-George Rahota , Timo F. W. SoeterikTimo F. W. Soeterik , Mathieu RoumiguiéMathieu Roumiguié , Hongqian GuoHongqian Guo , Agostino MatteiAgostino Mattei , Paolo GonteroPaolo Gontero , Giorgio GandagliaGiorgio Gandaglia , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001008792.09108.b4.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Discordance between initial biopsy results and subsequent radical prostatectomy (RP) specimen pathology for ISUP 4-5 patients is substantial even relying on the most contemporary combined mpMRI targeted (TBx) and systematic biopsy (SBx) diagnostic pathway, leading to challenges in risk stratification. While most studies have examined downgrading rates, they often overlook their clinical significance, leaving the factors influencing downgrading largely unexplored. We aimed to investigate rates of clinically significant downgrading and identify independent predictors. METHODS: We identified 356 patients with complete data treated with RP at ten tertiary referral centers (2014-2022), with a positive mpMRI and prostate cancer (PCa) ISUP 4-5 detected via SBx plus TBx. The outcome was a clinically significant PCa downgrading, defined as an ISUP 4-5 at biopsy to a lower ISUP (1-3) at RP. Multivariable logistic regression models (MVA) were fitted to identify independent predictors of downgrading using the following covariates: PSA, pattern Gleason score patterns at SBx and TBx, index lesion (IL) diameter, and SBx and TBx core ratios. The accuracy was quantified using the area under the receiver-operating curve (AUC). RESULTS: Overall, 155 (44%) patients exhibited clinically significant downgrading at RP. In total, 192 (54%) demonstrated concordant ISUP results at both SBx and TBx, while 95 (27%) exhibited higher ISUP scores at TBx, and 69 (19%) had higher ISUP scores at SBx. Of those groups, 58 (30%), 56 (59%), and 41 (59%) exhibited downgrading at RP, respectively. At MVA, patients with discordant ISUP at both SBx and TBx (OR: 3.44) and Gleason grade pattern 4+4 (OR: 3.77) were more likely to exhibit downgrading at RP (all p<0.001). Moreover, patients with larger IL (OR: 0.94, p=0.02) were less likely to exhibit downgrading at RP. The inclusion of SBx information to TBx core ratios increase the accuracy of the model from 0.76 to 0.78. CONCLUSIONS: We found that 44% of men with high risk disease at biopsy experienced clinically significant downgrading to lower Gleason score at RP. Patients with discordant ISUP at SBx vs TBx and without Gleason pattern 5 have higher risk of disease downgrading. Thus, in this subset of men if systematic biopsy was not performed, a significant risk of overtreatment such as long-term androgen deprivation therapy (ADT) instead of shorter ADT administration for those candidates to radiation therapy would exist. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e969 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Gabriele Sorce More articles by this author Armando Stabile More articles by this author Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Guillaume Ploussard More articles by this author Giancarlo Marra More articles by this author Massimo Valerio More articles by this author Riccardo Campi More articles by this author Andrea Minervini More articles by this author Sergio Serni More articles by this author Marco Moschini More articles by this author Alessandro Marquis More articles by this author Jean Baptiste Beauval More articles by this author Arnas Rakauskas More articles by this author Roderick van den Bergh More articles by this author Razvan-George Rahota More articles by this author Timo F. W. Soeterik More articles by this author Mathieu Roumiguié More articles by this author Hongqian Guo More articles by this author Agostino Mattei More articles by this author Paolo Gontero More articles by this author Giorgio Gandaglia More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...