Laparoscopic/ Robotic: Prostate

Moderated Poster Session

MP20-4 - Pathology correlation between MRI-US fusion biopsy and robotic radical prostatectomy specimen: a single center analysis

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 242B

Introduction & Objective :

Prostate cancer detection has been a challenge for many decades. Recently several studies have shown that the use of a software for fusion between pre-biopsy multiparametric MRI and ultrasound (US) during biopsy increases the cancer detection rate compared to standard biopsy. The goal of this study is to evaluate whether this advantage of MRI-US fusion biopsy translates into a better correlation with radical prostatectomy specimen.


Methods :

IRB approval was obtained per institutional protocol. Northwestern Enterprise Data Warehouse (EDW) was used to retrospectively collect data on patients undergoing robotic-assisted radical prostatectomy (RARP) from October 2013 to October 2017 as primary treatment for prostate cancer following detection by MRI-US-fusion guided biopsy with additional standard random biopsies. We assessed the correlation between the ISUP grade in targeted and random biopsy cores and RARP specimen, analyzing upgrade and attempting to determine pre-operative predictors of upgrade.


Results :

A total of 102 patients underwent primary RARP following MRI-US fusion biopsy during the study period and had all the necessary data. Cancer was detected solely in random cores in 19.6% of patients with 20% of these being upgraded on the RARP specimen. Among the 82 patients with positive targeted cores, addition of random biopsies significantly decreased the upgrade rate from 34.9% to 22.9% (p<0.001). Upgrade from targeted cores was significantly less frequent for higher PI-RADS lesions (55.6%, 34.8% and 19.0% respectively for PI-RADS 3, 4 and 5; p=0.002), but this correlation was no longer significant when controlling for PSA, number of positive cores and maximum core involvement (MCI). However, higher MCI was significantly associated with less upgrade both on uni- and multivariate analysis (p<0.001).
When looking at the targeted biopsies grade, there was upgrade in 78.2%, 26.4%, 18.2% and 0% of the ISUP 1, 2, 3 and 4 grades, respectively, with this correlation remaining significant after adjustment to other pre-operative variables (p<0.001). No correlation was found between upgrade and PSA, prostate volume or number of positive targeted cores.


Conclusions :

MRI-US fusion biopsy, although having a higher rate of cancer detection, still has a significant rate of upgrading on RP specimen; our study also shows that additional random biopsies decrease the overall risk of upgrading and therefore should not be omitted. In our cohort, lower MCI was a major predictor of upgrade, while PI-RADS only showed correlation in univariate analysis. When counselling patients we should also take in account that over 75% of Gleason 3+3 are upgraded. 

Ricardo O. Soares

Endourology Fellow
Northwestern University - Feinberg School of Medicine

MD and Urology residency in Portugal providing a solid and broad clinical experience in several urological areas with special interest in Uro-Oncology and Endourology.

Board certified since June 2013, following examination by the European Board of Urology.

For 3 years, worked as a Uro-Oncology Fellow in England (at University College of London Hospital and, from October 2013, at Royal Surrey County Hospital), including robotic / laparoscopic prostatectomy, robotic radical cystectomy, 4D LDR brachytherapy and blue-light cystoscopy. Completed the 6-month Certified Curriculum for Robotic Radical Prostatectomy of ERUS (European Associaton of Urology Robotic Urology Section).

Worked as Urology Attending in one of the top 5 Urology departments in England from August 2016 till June 2017, performing robotic prostatectomies, 4D LDR brachytherapy and General Urology.
Currently at Northwestern University, in Chicago, doing the 2-year Endourological Society Fellowship in robotic (prostate and kidney) and stone surgery.
Fluent in Portuguese (native), English, Spanish and French.
Permanent Resident in USA. Married, with one son.

https://uk.linkedin.com/in/ricardooliveirasoares

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    Eric Li

    Medical Student
    Northwestern University - Feinberg School of Medicine

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      Vidit Talati

      Medical Student
      Northwestern University - Feinberg School of Medicine

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        Robert B. Nadler

        Professor in Urology
        Northwestern Unioversity - Feinberg School of Medicine

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          Kent T. Perry

          Associate Professor of Urology
          Northwestern University - Feinberg School of Medicine

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