Targeted biopsy of the prostate: does this result in improvement in detection of high-grade cancer or the occurrence of the Will Rogers phenomenon?

Edward J Bass; Clement Orczyk; Alistair Grey; Alex Freeman; Charles Jameson; Shonit Punwani; Navin Ramachandran; Clare Allen; Mark Emberton; Hashim U Ahmed

doi:10.1111/bju.14806

Targeted biopsy of the prostate: does this result in improvement in detection of high-grade cancer or the occurrence of the Will Rogers phenomenon?

BJU Int. 2019 Oct;124(4):643-648. doi: 10.1111/bju.14806. Epub 2019 Jun 2.

Authors

Edward J Bass^{1

2}, Clement Orczyk^{1

2}, Alistair Grey^{1

2}, Alex Freeman³, Charles Jameson³, Shonit Punwani^{4

5}, Navin Ramachandran^{4

5}, Clare Allen^{4

5}, Mark Emberton^{1

2}, Hashim U Ahmed^{6

7}

Affiliations

¹ Division of Surgery and Interventional Science, University College London, London, UK.
² Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
³ Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK.
⁴ Division of Medicine, Centre for Medical Imaging, University College London, London, UK.
⁵ Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.
⁶ Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
⁷ Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.

PMID: 31081983
DOI: 10.1111/bju.14806

Abstract

Objective: To investigate whether patients with Gleason 3 + 4 cancer on transrectal biopsy are upgraded after undergoing transperineal magnetic resonance imaging (MRI)-targeted biopsy and whether this has implications for current clinical practice.

Patients and methods: In this retrospective analysis we examined 107 consecutive patients presenting at a single tertiary referral centre (July 2012 to July 2016) with prostate cancer of Gleason score 3 + 4 on transrectal ultrasonography (TRUS)-guided systematic non-targeted biopsy who then underwent a multiparametric MRI followed by MRI-targeted transperineal prostate biopsy for accurate risk stratification and localization.

Results: The patients' mean (sd) age was 67.0 (8.0) years, and they had a median (interquartile range) PSA concentration of 6.2 (4.7-9.6) ng/mL. Of the 107 patients, 84 (78.5%) had Gleason 3 + 4 on both transrectal systematic biopsy and transperineal MRI-targeted biopsy. Nineteen patients (17.8%) were upgraded to Gleason 4 + 3, three patients (3.0%) to Gleason 4 + 4 and one patient (1.0%) to Gleason 4 + 5. These differences were significant (P = 0.0006). Likewise, 23/107 patients (22%) had higher-risk disease based on their targeted biopsies.

Conclusion: The use of targeted biopsy in men with impalpable cancer, ultimately upgraded one in five patients from favourable-intermediate- to unfavourable-intermediate-risk disease or worse. This has significant clinical implications for men considering active surveillance or radical treatment. Our risk calculators must now be validated using these data from targeted biopsy as the technique becomes widely adopted.

Keywords: #PCSM; #ProstateCancer; Will Rogers phenomenon; biopsy; epidemiology; histology.

Abstract

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