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The role of MRI-targeted and confirmatory biopsies for cancer upstaging at selection in patients considered for active surveillance for clinically low-risk prostate cancer

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Abstract

Purpose

The purpose of this study was to assess the roles of MRI-targeted biopsies (TB) and confirmatory biopsies for cancer upstaging at selection in patients considered for active surveillance (AS) for low-risk prostate cancer (PCa) based on the first systematic biopsy (SB) series in another centre.

Methods

From 2009 to 2012, 41 patients with PCa diagnosed within the last 4 months and eligible for AS [clinical stage ≤T2a, prostate-specific antigen (PSA) <10 ng/ml, ≤2 positive biopsy cores with no Gleason pattern 4 or 5 and ≤5 mm involvement of any biopsy core] underwent pre-biopsy MRI, confirmatory transrectal ultrasound 12-core SB and MRI-TB of suspicious lesions. A contingency table assessed the accuracy of MRI to predict cancer upstaging.

Results

Median age and PSA were 63.5 years and 5.3 ng/ml, respectively. Overall, 24 patients (59 %) were upstaged. This upstaging was obtained at a confirmatory SB in 16 patients (39 %) based on the Gleason score (9), on cancer length (8) or both (7) and at MRI-TB in 17 patients (41 %) based on the Gleason score (14), cancer length (9) or both (6). Nine patients were upstaged at both SB and TB (22 %). The added value of MRI-TB was 20 % (8/41). The positive and negative predictive values of MRI for predicting cancer upstaging were 79 and 70.5 %, respectively.

Conclusion

MRI-TB and confirmatory SB upstaged 59 % of cases, improving the selection of patients considered for AS at the first series of SB. Variation in histologic grade assignation between centres and better cancer sampling may explain this high upstaging rate.

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Authors and Affiliations

  1. Department of Urology, CHU Lille, Univ Lille Nord de France, 59000, Lille, France

    François Marliere, Ahmed Benkirane, Arnauld Villers & Adil Ouzzane

  2. Department of Radiology, CHU Lille, Univ Lille Nord de France, 59000, Lille, France

    Philippe Puech & Laurent Lemaitre

  3. Department of Pathology, CHU Lille, Univ Lille Nord de France, 59000, Lille, France

    Xavier Leroy

  4. Inserm U703, CHRU Lille, Univ Lille Nord de France, 59120, Loos, France

    Arnauld Villers, Laurent Lemaitre, Nacim Betrouni & Adil Ouzzane

  5. Department of Urology, Hôpital Claude Huriez, Rue Michel Polonovski, 59000, Lille, France

    Adil Ouzzane

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  1. François Marliere
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  2. Philippe Puech
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  3. Ahmed Benkirane
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  4. Arnauld Villers
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  5. Laurent Lemaitre
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  6. Xavier Leroy
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  7. Nacim Betrouni
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  8. Adil Ouzzane
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Correspondence to Adil Ouzzane.

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Marliere, F., Puech, P., Benkirane, A. et al. The role of MRI-targeted and confirmatory biopsies for cancer upstaging at selection in patients considered for active surveillance for clinically low-risk prostate cancer. World J Urol 32, 951–958 (2014). https://doi.org/10.1007/s00345-014-1314-5

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  • DOI: https://doi.org/10.1007/s00345-014-1314-5

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