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Sorce G, Stabile A, Pellegrino F, Mazzone E, Mattei A, Afferi L, Serni S, Minervini A, Roumiguiè M, Malavaud B, Valerio M, Rakauskas A, Marra G, Gontero P, Porpiglia F, Guo H, Zhuang J, Gandaglia G, Montorsi F, Briganti A. The impact of mpMRI-targeted vs systematic biopsy on the risk of prostate cancer downgrading at final pathology. World J Urol 2024; 42:248. [PMID: 38647689 DOI: 10.1007/s00345-024-04963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Although targeted biopsies (TBx) are associated with improved disease assessment, concerns have been raised regarding the risk of prostate cancer (PCa) overgrading due to more accurate biopsy core deployment in the index lesion. METHODS We identified 1672 patients treated with radical prostatectomy (RP) with a positive mpMRI and ISUP ≥ 2 PCa detected via systematic biopsy (SBx) plus TBx. We compared downgrading rates at RP (ISUP 4-5, 3, and 2 at biopsy, to a lower ISUP) for PCa detected via SBx only (group 1), via TBx only (group 2), and eventually for PCa detected with the same ISUP 2-5 at both SBx and TBx (group 3), using multivariable logistic regression models (MVA). RESULTS Overall, 12 vs 14 vs 6% (n = 176 vs 227 vs 96) downgrading rates were recorded in group 1 vs group 2 vs group 3, respectively (p < 0.001). At MVA, group 2 was more likely to be downgraded (OR 1.26, p = 0.04), as compared to group 1. Conversely, group 3 was less likely to be downgraded at RP (OR 0.42, p < 0.001). CONCLUSIONS Downgrading rates are highest when PCa is present in TBx only and, especially when the highest grade PCa is diagnosed by TBx cores only. Conversely, downgrading rates are lowest when PCa is identified with the same ISUP through both SBx and TBx. The presence of clinically significant disease at SBx + TBx may indicate a more reliable assessment of the disease at the time of biopsy potentially reducing the risk of downgrading at final pathology.
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Affiliation(s)
- G Sorce
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - A Stabile
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - F Pellegrino
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - E Mazzone
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - A Mattei
- Klinik Für Urologie, Luzerner Kantonsspital, Luzerner, Switzerland
| | - L Afferi
- Klinik Für Urologie, Luzerner Kantonsspital, Luzerner, Switzerland
| | - S Serni
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - A Minervini
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - M Roumiguiè
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - B Malavaud
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - M Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Rakauskas
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - G Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - P Gontero
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - F Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - H Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - J Zhuang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - G Gandaglia
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - F Montorsi
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - A Briganti
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Stabile A, Gandaglia G, Pellegrino F, Afferi L, Zhuang J, Guo H, Gontero P, Minervini A, Ploussard G, Mazzone E, Valerio M, Cucchiara V, Fossati N, Moschini M, Mattei A, Serni S, Rahota R, Beauval J, Marquis A, Rakauskas A, Van Den Bergh R, Soeterik T, Montorsi F, Briganti A. mpMRI of the prostate in patients carrying a high clinical risk of prostate cancer diagnosis: Is this imaging test necessary for diagnostic purposes in this subset of patients? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Stabile A, Gandaglia G, Pellegrino F, Mazzone E, Cucchiara V, Fossati N, Moschini M, Mattei A, Afferi L, Serni S, Minervini A, Rahota RG, Ploussard G, Valerio M, Beauval J, Marquis A, Rakauskas A, Gontero P, Guo H, Zhuang J, Van Den Bergh R, Soeterik T, Montorsi F, Briganti A. Integrating index lesion volume to better classify men with indolent prostate cancer among patients with intermediate risk disease. Results from a large, multi-institutional series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Sorce G, Gandaglia G, Stabile A, Cucchiara V, Mazzone E, Fossati N, Moschini M, Mattei A, Afferi L, Serni S, Minervini A, Rahota RG, Ploussard G, Valerio M, Beavaul J, Marquis A, Rakauskas A, Gontero P, Guo H, Zhuang J, Van Den Bergh R, Soeterik T, Montorsi F, Briganti A. Has the introduction of multiparametric magnetic resonance imaging of the prostate and targeted biopsies led to a risk of overgrading of high risk prostate cancer? Results from a contemporary, large multi-institutional series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Schaer S, Rakauskas A, Valerio M, Roth B. A preliminary assessment of microultrasound performance in detecting clinically significant prostate cancer in the anterior prostate: An inter-reader evaluation. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Martini A, Wever L, Soeterik T, Rakauskas A, Fankhauser C, Grogg J, Checcucci E, Ploussard G, Qiang P, Affentranger A, Marra G, Ettala O, Zattoni F, Falagario U, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Olivier J, Radtke J, Carrieri G, Jambor I, Gontero P, Briganti A, Macek P, Chiu P, Hermanns T, Van Den Bergh R, Gandaglia G, Valerio M. Unilateral pelvic lymph node dissection in prostate cancer patients diagnosed in the era of MRI-targeted biopsy: A study that challenges the dogma. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Gandaglia G, Mazzone E, Ploussard G, Marra G, Valerio M, Campi R, Mari A, Minervini A, Serni S, Moschini M, Marquis A, Beauval J, Rakauskas A, Sessa F, van den Bergh R, Rahota R, Soeterik T, Roumiguiè M, Afferi L, Zhuang J, Guo H, Mattei A, Gontero P, Cucchiara V, Stabile A, Fossati N, Montorsi F, Briganti A. Outcomes of prostate cancer patients with seminal vesicle invasion at multiparametric MRI managed with radical prostatectomy. Do all patients really need for a multi-modal approach? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Martel P, Rakauskas A, Dagher J, La Rosa S, Meuwly JY, Roth B, Valerio M. The benefit of adopting Microultrasound in the prostate cancer imaging pathway: A lesion-by-lesion analysis: Biopsies prostatiques guidée par micro-échographie, quel bénéfice ? Une analyse lésion par lésion. Prog Urol 2022; 32:6S26-6S32. [PMID: 36719643 DOI: 10.1016/s1166-7087(22)00172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION - Microultrasound (MicroUS) is a novel imaging modality relying on a high-frequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional benefit of employing MicroUS. METHODS - Retrospective analysis of consecutive treatment-naïve men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS ≥ 3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically significant prostate cancer, defined as Gleason pattern ≥ 4 at histology. RESULTS - In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16 ng/ml/cc (0.10-0.23) were included. Clinically significant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically significant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identified 35 suspicious lesions non-visible on MRI of which clinically significant cancer was present in 25.7% (9/35). CONCLUSION - Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically significant disease in unselected men undergoing biopsy. © 2022 Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- P Martel
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - A Rakauskas
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - J Dagher
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - S La Rosa
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland; Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - J Y Meuwly
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - B Roth
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - M Valerio
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland.
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Martel P, Rakauskas A, Dagher J, La Rosa S, Meuwly JY, Roth B, Valerio M. WITHDRAWN: The benefit of adopting Microultrasound in the prostate cancer imaging pathway : A lesion-by-lesion analysis. Prog Urol 2022:S1166-7087(22)00066-5. [PMID: 35292179 DOI: 10.1016/j.purol.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Microultrasound (MicroUS) is a novel imaging modality relying on a high-frequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional benefit of employing MicroUS. METHODS Retrospective analysis of consecutive treatment-naïve men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS≥3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically significant prostate cancer, defined as Gleason pattern≥4 at histology. RESULTS In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16ng/ml/cc (0.10-0.23) were included. Clinically significant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically significant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identified 35 suspicious lesions non-visible on MRI of which clinically significant cancer was present in 25.7% (9/35). CONCLUSION Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically significant disease in unselected men undergoing biopsy.
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Affiliation(s)
- P Martel
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - A Rakauskas
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - J Dagher
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - S La Rosa
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland; Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - J Y Meuwly
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - B Roth
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - M Valerio
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland.
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Gandaglia G, Mazzone E, Ploussard G, Marra G, Valerio M, Campi R, Mari A, Minervini A, Serni S, Moschini M, Marquis A, Beauval JB, Rakauskas A, Sessa F, Van Den Bergh R, Rahota RG, Soeterik T, Roumiguié M, Afferi L, Zhuang J, Guo H, Mattei A, Gontero P, Montorsi F, Briganti A. Definition and predictors of upgrading at final pathology in prostate cancer patients undergoing mri-targeted and systematic biopsies: Results from a large, multi-institutional series. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00700-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Reddy D, Peters M, Shah T, Van Son M, Bertoncelli Tanaka M, Huber P, Lomas D, Rakauskas A, Miah S, Eldred-Evans D, Hosking-Jervis F, Engle R, Dudderidge T, Mccracken S, Greene D, Nigam R, Mccartan N, Valerio M, Orczyk C, Virdi J, Arya M, Ahmed H. Primary focal cryotherapy for non-metastatic prostate cancer: Update from the UK ICE registry. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rakauskas A, Peters M, Martel P, La Rosa S, Meuwly JY, Roth B, Valerio M. Tranperineal vs. transrectal micro-ultrasound and mpMRI targeted prostate biopsies: propensity score-matched study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reddy D, Peters M, Shah T, Van Son M, Huber P, Lomas D, Rakauskas A, Miah S, Guillaumier S, Dudderidge T, Hindley R, Emara A, Nigam R, Valerio M, Afzal N, Lewi H, Orczyk C, Ogden C, Persad R, Virdi J, Moore C, Arya M, Winkler M, Emberton M, Ahmed H. Cancer control outcomes following focal therapy using HIFU in 1,829 men with non-metastatic prostate cancer treated over 15 years. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gandaglia G, Ploussard G, Valerio M, Mattei A, Marra G, Beauval J, Malavaud B, Roumiguié M, Marquis A, Fossati N, Scalvi F, Robesti D, Rizzo A, Stabile A, Afferi L, Moschini M, Rakauskas A, Van Den Bergh R, De Cobelli F, Fiori C, Porpiglia F, Gontero P, Montorsi F, Briganti A. The added value of concomitant systematic biopsy in predicting biochemical recurrence after radical prostatectomy in patients with prostate cancer diagnosed by MRI-targeted biopsy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gandaglia G, Ploussard G, Valerio M, Mattei A, Marra G, Beauval JB, Malavaud B, Roumiguié M, Marquis A, Afferi L, Moschini M, Fossati N, Bandini M, Cucchiara V, Stabile A, Bravi C, Rakauskas A, Van Den Bergh R, De Cobelli F, Fiori C, Porpiglia F, Gontero P, Montorsi F, Briganti A. When is mp-MRI reliable in predicting extra-prostatic extension in prostate cancer patients treated with radical prostatectomy? Results from a large, multi-institutional series. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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