Presentation Authors: Iskander Abdullin*, Filipp Kosov, Vladimir Kapustin, Vadim Panov, Ekaterina Baranova, Nikolay Grigoriev, Moscow, Russian Federation
Introduction: Underestimation of Gleason score after prostate biopsy is one of unsolved problems of Prostate Cancer (PC) diagnosis. Patients considered to be low risk PC undergo active surveillance, refuse from pelvic lymph nodes dissection during radical prostatectomy and experimental focal techniques. Underestimation of Gleason score results in high rates of low risk PC treatment failures. Opportunity of co-registration of multiparametric Magnetic Resonance Imaging (MRI) and Ultra Sound (US) images to perform targeted biopsy of index lesion is new option for clinically significant PC detection. The purpose of our study is to evaluate if MRI-US Fusion Biopsy (FB) can decrease the upgrading rate after radical prostatectomy comparing with Systemic Biopsy (SB).
Methods: We retrospectively analyzed single clinic database for patients who underwent MRI-US FB followed by radical prostatectomy in 2016 to 2018. We performed MRI-US FB in every patients with PSAâ‰¥2 ng/ml or positive digital rectal examination and if multiparametric MRI revealed lesions PIRADSâ‰¥3. The control group consisted of patients who underwent systematic 12-21 core biopsy followed by prostatectomy in 2015-2016, before the implementation of MRI-US FB in our clinic. Upgrade of Gleason score case was defined if final Gleason score was at least 1 point higher than after biopsy. The number of patients with Gleason upgrade after radical prostatectomy in both groups were compared.
Results: Included in study were 114 patients, 54 patients in MRI-US FB group and 60 patients in SB group. Mean patient age was 62,4 Â± 2,1 years in MRI-US FB group and 64,4 Â± 3,1 years in SB group. Mean PSA was 7,1 Â±2,3 ng/ml in MRI-FB group and 7,8 Â±3,2 ng/ml in SB group. Of 54 patients of MRI-US FB group in 12 (22%) Gleason score upgrade was revealed after radical prostatectomy while of 60 patients of SB group upgrade was revealed in 27 (45%) patients pâ‰¤ 0,05.
Conclusions: MRI-US FB significantly decreases the risk of upgrading after radical prostatectomy by better finding of index lesion. More precise stratification of patients on risk groups could make us more confident in choosing way of PC management. Implementation of MRI-US FB can result in less low risk PC treatment failures.