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[Online ahead of print]

Decreased Accuracy of the Prostate Cancer EAU Risk Group Classification in the Era of Imaging-Guided Diagnostic Pathway: Proposal for a New Classification Based on MRI-targeted Biopsies and Early Oncologic Outcomes After Surgery

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Decreased Accuracy of the Prostate Cancer EAU Risk Group Classification in the Era of Imaging-Guided Diagnostic Pathway: Proposal for a New Classification Based on MRI-targeted Biopsies and Early Oncologic Outcomes After Surgery

Guillaume Ploussard et al. World J Urol.

Abstract

Purpose: To assess the performance of EAU risk classification in PCa patients according to the biopsy pathway (standard versus MRI guided) and to develop a new, more accurate, targeted biopsy (TB)-based classification.

Materials and methods: We included 1345 patients consecutively operated by radical prostatectomy (RP) since 2014, when MRI and TB were introduced in the diagnostic pathway. Patients underwent systematic biopsy (SB) only (n = 819) or SB and TB (n = 526) prior to RP during the same time period. Pathological and biochemical outcomes were compared between PCa men undergoing SB (SB cohort) and a combination of TB and SB (TB cohort). Kaplan-Meier and Cox regression models were used to assess biochemical recurrence-free survival (RFS).

Results: Both cohorts were comparable regarding final pathology and RFS (p = 0.538). The EAU risk classification accurately predicted outcomes in SB cohort, but did not significantly separate low from intermediate risk in TB cohort (p = 0.791). In TB cohort, the new proposed three-group risk classification significantly improved the recurrence risk prediction compared with the EAU risk classification: HR 4 (versus HR 1.2, p = 0.009) for intermediate, and HR 15 (versus HR 6.5, p < 0.001) in high-risk groups, respectively. A fourth group defining very high-risk cases (≥ T2c clinical stage or grade group 5) was also proposed.

Conclusions: The new classification integrating TB findings we propose meaningfully improves the recurrence prediction after surgery in patients undergoing a TB-based diagnostic pathway, compared with standard EAU risk classification which is still relevant for patients undergoing only SB. External validation is needed.

Keywords: Biopsy; Fusion biopsies; MRI; Prostate cancer; Radical prostatectomy; Risk; Systematic biopsies; Targeted biopsies.

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