Moderated Poster

Poster, Podium & Video Sessions

MP08-12: Multi-institutional evaluation of MRI and Fusion Biopsy in Confirmatory Biopsy for Active Surveillance

Friday, May 12
9:30 AM - 11:30 AM
Location: BCEC: Room 160

Presentation Authors: Christopher M. Russell*, Amir H. Lebastchi, Matthew Lee, Scott A. Tomlins, Jeffrey S. Montgomery, Chandy S. Ellimoottil, Jont T. Wei, Matthew S. Davenport, Nicole Curci, Ann Arbor, MI, Thomas P. Frye, Matthew Truong, Rochester, NY, Srinivas Vourganti, Chicago, IL, Ardeshir Rastinehad, New York, NY, Paras Shah, Vinay Patel, Hempstead, NY, Arvin George, Ann Arbor, MI

Introduction: Preliminary single-institution data has suggested a benefit of prostate MRI and fusion biopsy (FBx) in evaluation of patients considered for active surveillance (AS). We aim to determine the utility of MRI/FBx for confirmation of AS candidacy and identify predictors of Gleason upgrading in a multi-institutional cohort of patients.

Methods: A retrospective review was completed at five tertiary referral centers to identify patients with Gleason 3+3=6 or Gleason 3+4=7 prostate cancer with PSA < 15 who underwent 3T prostate MRI and confirmatory FBx between 2012-2015. MRI regions of interest (ROI) were reported according to PIRADSv2 criteria. The primary outcome was Gleason score upgrading on targeted sampling when compared to pre-FBx standard 12-core biopsy (SBx). Univariate and multivariate analysis of variance were performed to identify clinical, imaging, and pathologic characteristics independently associated with Gleason score upgrading on fusion biopsy.

Results: A total of 225 patients were identified meeting inclusion criteria, of which 209 (93%) had Gleason 3+3=6 and 16 (12%) had Gleason 3+4=7 disease on SBx. Confirmatory FBx resulted in Gleason score upgrading within the targeted ROI in 90 patients (40%). Detailed patient demographics and pathologic characteristics are depicted in Table 1. FBx did not miss any high risk PCa, while identifying 10 patients (12.5%) with high risk disease missed on SBx alone. Patient age (p=0.003), pre-fusion biopsy PSA (p=0.020), initial standard 12-core Gleason score (p=0.070), prostate volume (p=0.003), and PI-RADSv2 classification (p=0.056) were found to be associated with confirmatory FBx upgrading on univariate analysis. Multivariate analysis demonstrated a significant and independent association of patient age (p=0.001), pre-fusion biopsy PSA (p=0.006), prostate volume (p=0.020), and PI-RADSv2 classification (p=0.050) with FBx upgrading.

Conclusions: Confirmatory FBx improves risk stratification of patients considering AS. Age, pre-FBx PSA, prostate volume, and PI-RADSv2 classification were independently associated with Gleason score upgrading on confirmatory FBx.

Source Of Funding: None

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