Targeted biopsy of the prostate: Does this result in improvement in detection of high-grade cancer or the occurrence of the Will Rogers phenomenon?
File(s)
Accepted version
Author(s)
Type
Journal Article
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.
Date Issued
2019-10
Date Acceptance
2019-05-01
Citation
BJU International, 2019, 124 (4), pp.643-648
ISSN
1464-4096
Publisher
Wiley
Start Page
643
End Page
648
Journal / Book Title
BJU International
Volume
124
Issue
4
Copyright Statement
© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd. This is the post-peer reviewed version of the following article: Bass, E. J., Orczyk, C. , Grey, A. , Freeman, A. , Jameson, C. , Punwani, S. , Ramachandran, N. , Allen, C. , Emberton, M. and Ahmed, H. U. (2019), 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. doi:10.1111/bju.14806, which has been published in final form at https://dx.doi.org/10.1111/bju.14806
Sponsor
Wellcome Trust
University College London Hospitals Charity
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31081983
Grant Number
204998/Z/16/Z
1348
Subjects
#PCSM
#ProstateCancer
Will Rogers phenomenon
biopsy
epidemiology
histology
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2019-05-13