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A comprehensive comparison between mpMRI of the prostate, MR-US fusion biopsy and whole mount histopathology

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Abstract

Objectives

To compare multiparametric magnetic resonance imaging (mpMRI) findings, US-MR fusion prostate biopsy results and whole-mount thin-section histopathology after radical prostatectomy.

Patients and methods

Overall 259 patients, who had undergone mpMRI with lesions reported as PI-RADS 3-5, underwent a MR-US fusion biopsy between 2018 and 2020. Overall 186 biopsies yielded prostate cancer and 104 patients subsequently underwent endoscopic extraperitoneal radical prostatectomy. Histopathology of biopsies was compared to the final histopathology in whole mount thin sections after radical prostatectomy by means of descriptive statistics, and further, the lesions from mpMRT were compared to whole mount histology.

Results

Prostate cancer was diagnosed in 186 (71.8%) of 259 patients (median age 69.2 y, range 42–82 y, median PSA 7.8 ng/ml, range 2.1–31.3 ng/ml). Of those, 95 (51,1%) underwent radical endoscopic prostatectomy, and 80 (43%) chose radiotherapy or active surveillance. In 52/95 (54,7%) with RPE additional lesions were found in the final histological whole mount sections not described at mpMRI. 22/95 (23,2%) of RPE patients had ≥ 1 additional Gleason score ≥ 7 lesions, 23 /259 (8,4%) of biopsies, respectively. The Gleason score after surgery was upgraded in 37/95 (38,9%) and downgraded in 18/95 (18,9%) patients.

Conclusion

If we compare all 259 performed biopsies with the final histological whole mount sections which showed additional lesions with Gleason ≥ 7 (23,2%), it can be assumed that up to 10% of clinical significant carcinomas are missed during primary assessment via mpMRI. The majority of additional findings after RP were intermediate/high risk tumors. Upgrades from low-risk to intermediate or high-risk occurred.

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Authors and Affiliations

  1. Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria

    Stephan Doblhammer, Paul Kinger, Maria Starmuehler & Clemens Broessner

  2. Medical Department II, Barmherzige Schwestern Krankenhaus, Vienna, Austria

    Christian Muschitz

  3. Department of Radiology, Barmherzige Schwestern Krankenhaus, Vienna, Austria

    Wolfgang Schima

  4. Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria

    Martin Susani

  5. Department of Statistics and Operations Research, University of Vienna, Vienna, Austria

    Andreas Baierl

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  1. Stephan Doblhammer
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  2. Paul Kinger
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  3. Maria Starmuehler
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  4. Christian Muschitz
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  5. Wolfgang Schima
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  8. Clemens Broessner
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Correspondence to Stephan Doblhammer.

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Doblhammer, S., Kinger, P., Starmuehler, M. et al. A comprehensive comparison between mpMRI of the prostate, MR-US fusion biopsy and whole mount histopathology. World J Urol 41, 1055–1060 (2023). https://doi.org/10.1007/s00345-023-04339-6

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  • DOI: https://doi.org/10.1007/s00345-023-04339-6

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