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01-09-2021 | Prostate Cancer | Original Article

The prognostic value of high-grade prostate cancer pattern on MRI-targeted biopsies: predictors for downgrading and importance of concomitant systematic biopsies

Authors: Cécile Manceau, Gaëlle Fromont-Hankard, Jean-Baptiste Beauval, Marine Lesourd, Christophe Almeras, Anne-Sophie Bajeot, Jean-Romain Gautier, Michel Soulié, Guillaume Loison, Ambroise Salin, Christophe Tollon, Bernard Malavaud, Mathieu Roumiguié, Guillaume Ploussard

Published in: World Journal of Urology | Issue 9/2021

Abstract

Purpose

To assess the proportion and risk factors for downgrading and reclassification to favorable disease in patients having high-grade (HG) prostate cancer (PCa) pattern on magnetic resonance imaging (MRI)-targeted-biopsy (TB).

Methods

From a radical prostatectomy (RP) cohort, we included patients with pre-biopsy positive MRI and HG [defined by Grade Group (GG) ≥ 3] PCa on MRI-TB. All patients also underwent concomitant systematic biopsy (SB). The main endpoints were the rates of downgrading to GG2, overall downgrading, favorable disease (pT2 and GG2) on RP specimens, and biochemical recurrence-free-survival (RFS). We studied the correlations between HG on concomitant SB, final pathological outcomes and biochemical RFS curves.

Results

Overall downgrading, downgrading to GG2 disease and favorable disease were noted in 36.2%, 24.1%, and 15.4% respectively. HG on concomitant SB was correlated with pT3-4 disease (p < 0.001), pN1 disease (p < 0.001), positive surgical margins (p = 0.043), PSA recurrence (p = 0.003). In multivariable analysis, the presence of GG4-5 on TB (p = 0.013; OR 0.263) and the presence of HG on concomitant SB (p = 0.010; OR 0.269) were negatively and independently correlated with the risk of downgrading to GG2. The presence of HG on concomitant SB independently predicted RFS with a hazard ratio of 2.173 (p = 0.049; 95% CI 1.005–4.697).

Conclusions

Our data shows that a limited HG restricted to TB can often be associated with a favorable grade in almost a quarter of the cases and downgraded in almost half of the cases. Detailed SB features, mainly the presence of HG on concomitant SB, was associated with a more accurate pathology and oncologic outcomes prediction, pleading for the maintenance of SB in MRI-positive patients.

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Title: The prognostic value of high-grade prostate cancer pattern on MRI-targeted biopsies: predictors for downgrading and importance of concomitant systematic biopsies
Authors: Cécile Manceau
Gaëlle Fromont-Hankard
Jean-Baptiste Beauval
Marine Lesourd
Christophe Almeras
Anne-Sophie Bajeot
Jean-Romain Gautier
Michel Soulié
Guillaume Loison
Ambroise Salin
Christophe Tollon
Bernard Malavaud
Mathieu Roumiguié
Guillaume Ploussard
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Prostate Cancer
Prostatectomy
Prostatectomy
Published in: World Journal of Urology / Issue 9/2021
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-021-03631-7

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Springer Medicine

The prognostic value of high-grade prostate cancer pattern on MRI-targeted biopsies: predictors for downgrading and importance of concomitant systematic biopsies

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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