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The impact of mpMRI-targeted vs systematic biopsy on the risk of prostate cancer downgrading at final pathology

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Abstract

Purpose

Although targeted biopsies (TBx) are associated with improved disease assessment, concerns have been raised regarding the risk of prostate cancer (PCa) overgrading due to more accurate biopsy core deployment in the index lesion.

Methods

We identified 1672 patients treated with radical prostatectomy (RP) with a positive mpMRI and ISUP ≥ 2 PCa detected via systematic biopsy (SBx) plus TBx. We compared downgrading rates at RP (ISUP 4–5, 3, and 2 at biopsy, to a lower ISUP) for PCa detected via SBx only (group 1), via TBx only (group 2), and eventually for PCa detected with the same ISUP 2–5 at both SBx and TBx (group 3), using multivariable logistic regression models (MVA).

Results

Overall, 12 vs 14 vs 6% (n = 176 vs 227 vs 96) downgrading rates were recorded in group 1 vs group 2 vs group 3, respectively (p < 0.001). At MVA, group 2 was more likely to be downgraded (OR 1.26, p = 0.04), as compared to group 1. Conversely, group 3 was less likely to be downgraded at RP (OR 0.42, p < 0.001).

Conclusions

Downgrading rates are highest when PCa is present in TBx only and, especially when the highest grade PCa is diagnosed by TBx cores only. Conversely, downgrading rates are lowest when PCa is identified with the same ISUP through both SBx and TBx. The presence of clinically significant disease at SBx + TBx may indicate a more reliable assessment of the disease at the time of biopsy potentially reducing the risk of downgrading at final pathology.

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Data availability

Analyses relied on a review-board-approved database. Due to the anonymously coded design of the database, study-specific Institutional Review Board ethics approval was not required.

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Funding

The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author information

Authors and Affiliations

  1. Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy

    G. Sorce, A. Stabile, F. Pellegrino, E. Mazzone, G. Gandaglia, F. Montorsi & A. Briganti

  2. Klinik Für Urologie, Luzerner Kantonsspital, Luzerner, Switzerland

    A. Mattei & L. Afferi

  3. Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy

    S. Serni & A. Minervini

  4. Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France

    M. Roumiguiè & B. Malavaud

  5. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    M. Valerio & A. Rakauskas

  6. Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy

    G. Marra & P. Gontero

  7. Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy

    F. Porpiglia

  8. Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China

    H. Guo & J. Zhuang

  9. Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    A. Stabile

Authors
  1. G. Sorce
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  2. A. Stabile
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  3. F. Pellegrino
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  16. H. Guo
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  18. G. Gandaglia
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  19. F. Montorsi
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  20. A. Briganti
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Corresponding author

Correspondence to A. Stabile.

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Sorce, G., Stabile, A., Pellegrino, F. et al. The impact of mpMRI-targeted vs systematic biopsy on the risk of prostate cancer downgrading at final pathology. World J Urol 42, 248 (2024). https://doi.org/10.1007/s00345-024-04963-w

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