Christian Arsov1, Nikolaus Becker2, Robert Rabenalt3, Andreas Hiester3, Michael Quentin4, Frederic Dietzel4, Gerald Antoch4, Helmut E Gabbert5, Peter Albers3, Lars Schimmöller4. 1. Department of Urology, Medical Faculty, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany. christian.arsov@med.uni-duesseldorf.de. 2. Division of Cancer Epidemiology (C020), German Cancer Research Center Heidelberg, 69120, Heidelberg, Germany. 3. Department of Urology, Medical Faculty, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany. 4. Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University, 40225, Düsseldorf, Germany. 5. Department of Pathology, Medical Faculty, Heinrich-Heine University, 40225, Düsseldorf, Germany.
Abstract
PURPOSE: Gleason grading is the strongest predictor of prostate cancer outcome and commonly used to decide for or against the different treatment options. However, Gleason upgrading between systematic transrectal ultrasound-guided prostate biopsy (TRUS-GB) and radical prostatectomy (RPE) has frequently been observed. With respect to the high accuracy of multiparametric MRI (mpMRI) for high-grade cancers and the higher percentage of cancer involvement per biopsy core in targeted MR-guided prostate biopsy (MR-GB), we hypothesized that MR-GB reduces the risk of Gleason upgrading on RPE as compared to the gold standard. The purpose of this study was to compare the rate of Gleason upgrading on RPE for MR-GB, TRUS-GB, and the combination of both biopsy modalities. METHODS: Overall, 52 consecutive patients with RPE had received an mpMRI of the prostate and subsequently underwent targeted MR-GB prior to surgery. All patients underwent an additional TRUS-GB during the same biopsy session. Gleason grading was measured by two different methods: the conventional Gleason score (cGS = primary + secondary pattern) and the highest Gleason pattern (hGP). RESULTS: In relation to TRUS-GB, MR-GB alone showed lower rates of upgrading when comparing the cGS (40.4 vs. 50.0 %) and the hGP (21.2 vs. 32.7 %). The combination of MR-GB and TRUS-GB showed the lowest rates of upgrading (cGS: 28.8 %; hGP: 11.5 %), and compared to TRUS-GB, significantly reduced the risk of upgrading for both measurements of Gleason grading (cGS: OR 0.41, 95 % CL 0.18-0.91, p = 0.0289; hGP: OR 0.27, 95 % CL 0.10-0.75, p = 0.0123). CONCLUSION: MpMRI and targeted MR-GB are useful tools to better characterize and stage the extent of disease, and therefore enable the urologist to better risk-stratify and counsel the patient. The combined use of targeted MR-GB and TRUS-GB presents the least risk of Gleason underestimation.
PURPOSE: Gleason grading is the strongest predictor of prostate cancer outcome and commonly used to decide for or against the different treatment options. However, Gleason upgrading between systematic transrectal ultrasound-guided prostate biopsy (TRUS-GB) and radical prostatectomy (RPE) has frequently been observed. With respect to the high accuracy of multiparametric MRI (mpMRI) for high-grade cancers and the higher percentage of cancer involvement per biopsy core in targeted MR-guided prostate biopsy (MR-GB), we hypothesized that MR-GB reduces the risk of Gleason upgrading on RPE as compared to the gold standard. The purpose of this study was to compare the rate of Gleason upgrading on RPE for MR-GB, TRUS-GB, and the combination of both biopsy modalities. METHODS: Overall, 52 consecutive patients with RPE had received an mpMRI of the prostate and subsequently underwent targeted MR-GB prior to surgery. All patients underwent an additional TRUS-GB during the same biopsy session. Gleason grading was measured by two different methods: the conventional Gleason score (cGS = primary + secondary pattern) and the highest Gleason pattern (hGP). RESULTS: In relation to TRUS-GB, MR-GB alone showed lower rates of upgrading when comparing the cGS (40.4 vs. 50.0 %) and the hGP (21.2 vs. 32.7 %). The combination of MR-GB and TRUS-GB showed the lowest rates of upgrading (cGS: 28.8 %; hGP: 11.5 %), and compared to TRUS-GB, significantly reduced the risk of upgrading for both measurements of Gleason grading (cGS: OR 0.41, 95 % CL 0.18-0.91, p = 0.0289; hGP: OR 0.27, 95 % CL 0.10-0.75, p = 0.0123). CONCLUSION: MpMRI and targeted MR-GB are useful tools to better characterize and stage the extent of disease, and therefore enable the urologist to better risk-stratify and counsel the patient. The combined use of targeted MR-GB and TRUS-GB presents the least risk of Gleason underestimation.
Entities:
Keywords:
Gleason grading; Gleason score; Image-guided prostate biopsy; MR-guided prostate biopsy; Magnetic resonance imaging; Prostate cancer
Authors: Michael Quentin; Dirk Blondin; Christian Arsov; Lars Schimmöller; Andreas Hiester; Erhard Godehardt; Peter Albers; Gerald Antoch; Robert Rabenalt Journal: J Urol Date: 2014-05-24 Impact factor: 7.450
Authors: Qiang Fu; Judd W Moul; Lionel L Bañez; Leon Sun; Vladimir Mouraviev; Dongha Xie; Thomas J Polascik Journal: Med Oncol Date: 2012-06-12 Impact factor: 3.064
Authors: Marc A Dall'Era; Peter C Albertsen; Christopher Bangma; Peter R Carroll; H Ballentine Carter; Matthew R Cooperberg; Stephen J Freedland; Laurence H Klotz; Christopher Parker; Mark S Soloway Journal: Eur Urol Date: 2012-06-07 Impact factor: 20.096
Authors: Anthony V D'Amico; Judd Moul; Peter R Carroll; Leon Sun; Deborah Lubeck; Ming-Hui Chen Journal: J Clin Oncol Date: 2003-06-01 Impact factor: 44.544
Authors: R Jüri Palisaar; Markus Graefen; Pierre I Karakiewicz; Peter G Hammerer; Edith Huland; Alexander Haese; Salvator Fernandez; Andreas Erbersdobler; Rolf-Peter Henke; Hartwig Huland Journal: Eur Urol Date: 2002-02 Impact factor: 20.096
Authors: L Schimmöller; M Quentin; D Blondin; F Dietzel; A Hiester; C Schleich; C Thomas; R Rabenalt; H E Gabbert; P Albers; G Antoch; C Arsov Journal: Eur Radiol Date: 2016-02-26 Impact factor: 5.315
Authors: A Pichon; Y Neuzillet; H Botto; J-P Raynaud; C Radulescu; V Molinié; J-M Herve; T Lebret Journal: Prostate Cancer Prostatic Dis Date: 2015-10-06 Impact factor: 5.554
Authors: Annerleim Walton-Diaz; Manuel Madariaga-Venegas; Nicolas Aviles; Juan Carlos Roman; Ivan Gallegos; Mauricio Burotto Journal: Curr Urol Rep Date: 2019-09-02 Impact factor: 3.092
Authors: Sadhna Verma; Peter L Choyke; Steven C Eberhardt; Aytekin Oto; Clare M Tempany; Baris Turkbey; Andrew B Rosenkrantz Journal: Radiology Date: 2017-11 Impact factor: 11.105
Authors: Daniel B Dix; Andrew M McDonald; Jennifer B Gordetsky; Jeffrey W Nix; John V Thomas; Soroush Rais-Bahrami Journal: Urology Date: 2018-08-30 Impact factor: 2.649
Authors: B Valentin; L Schimmöller; T Ullrich; M Klingebiel; D Demetrescu; L M Sawicki; J Lakes; D Mally; M Quentin; I Esposito; P Albers; G Antoch; C Arsov Journal: Abdom Radiol (NY) Date: 2021-01-16
Authors: M J Scheltema; K J Tay; A W Postema; D M de Bruin; J Feller; J J Futterer; A K George; R T Gupta; F Kahmann; C Kastner; M P Laguna; S Natarajan; S Rais-Bahrami; A R Rastinehad; T M de Reijke; G Salomon; N Stone; R van Velthoven; R Villani; A Villers; J Walz; T J Polascik; J J M C H de la Rosette Journal: World J Urol Date: 2016-09-16 Impact factor: 4.226
Authors: Mike Wenzel; Felix Preisser; Clarissa Wittler; Benedikt Hoeh; Peter J Wild; Alexandra Tschäbunin; Boris Bodelle; Christoph Würnschimmel; Derya Tilki; Markus Graefen; Andreas Becker; Pierre I Karakiewicz; Felix K H Chun; Luis A Kluth; Jens Köllermann; Philipp Mandel Journal: Diagnostics (Basel) Date: 2021-05-15
Authors: Iulia Andras; Emanuel Darius Cata; Andreea Serban; Pierre Kadula; Teodora Telecan; Maximilian Buzoianu; Maria Bungardean; Dan Vasile Stanca; Ioan Coman; Nicolae Crisan Journal: Medicina (Kaunas) Date: 2021-05-22 Impact factor: 2.430