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2020 CUA Abstracts
UP-1.14. Table 1. Patient characteristics UP-1.14. Table 3. Odds ratios of correctly predicting
TRUS MRI-fusion post-RP NCCN risk
(n=503) biopsy (n=74) Odds 95% CI p
Median age (range) 62 (41–78) 65 (48–75) ratio
Race (%) TRUS vs. MRI-targeted biopsy 20.064 11.301–35.621 <0.0001
White 440 (88) 67 (91) PSA 0.998 0.972–1.024 0.8706
Black 52 (10) 4 (5) Age 1.035 1.001–1.071 0.0414
Other 11 (2) 3 (4)
PSA (ng/dl) (mean ± SD) 9.22±8.6 9.98±8.87 and risk scores 5 and 6 showing slight underprediction. Upstaging raged
Biopsy Gleason grade group (%) from 0.0–37.5% in the MRI-targeted biopsy vs. 65.0–100.0% in the TRUS
1 73 (14.5) 0 (0) cohort. In the TRUS cohort, 28.03% of patients were upstaged by more
2 237 (47) 32 (44) than one stage post-RP compared to only 4.05% in the MRI-targeted
biopsy cohort . On MVA, the odds ratio for predicting NCCN risk was 20.1
3 78 (15.5) 12 (16) times greater for MRI-targeted biopsy versus TRUS (p<0.0001) (Table 3).
4 42 (8.5) 9 (12) Conclusions: MRI-targeted biopsy was superior to TRUS in correctly pre-
5 73 (14.5) 21 (28) dicting post-RP NCCN risk stratification. Additionally, upstaging occurred
RP Gleason grade group (%) much more often in those undergoing TRUS compared to MRI-targeted
1 28 (5.5) 1 (1.3) biopsy. Ultimately, these outcomes have significant implications for the
2 239 (47.5) 31 (42.7) diagnosis and staging of prostate cancer and emphasize the need for tran-
3 108 (21.5) 21 (28) sition from TRUS biopsies to MRI-fusion biopsies as the standard of care.
References
4 43 (8.5) 3 (4) 1. Xu N, Wu YP, Li XD, et al. Risk of upgrading from prostate biopsy
5 85 (17) 18 (24) to radical prostatectomy pathology: Is magnetic resonance imaging-
Biopsy NCCN risk stratification (%) guided biopsy more accurate. J Cancer 2018;9:3634-9. https://doi.
1-Very-low 23 (4.5) 0 (0) org/10.7150/jca.26791
2-Low 34 (6.75) 0 (0) 2. Drost FH, Osses D, Nieboer D, et al. Prostate magnetic resonance
3-Favorable-intermediate 186 (37) 25 (34.7) imaging, with or without magnetic resonance imaging-targeted
4-Unfavorable-intermediate 124 (24.65) 19 (25.3) biopsy, and systematic biopsy for detecting prostate cancer: A
Cochrane systematic review and meta-analysis. Eur Urol 2020;77:78-
5-High 88 (17.5) 11 (14.7) 94. https://doi.org/10.1016/j.eururo.2019.06.023
6-Very-high 48 (9.6) 19 (25.3)
RP NCCN risk stratification (%) UP-1.15
1-Very-low 1 (0.2) 1 (0.2) Is confirmatory biopsy useful prior to radical prostatectomy for
2-Low 7 (1.4) 7 (1.4) patients on active surveillance who receive magnetic resonance
3-Favorable-intermediate 190 (37.8) 190 (37.8) imaging?
4-Unfavorable-intermediate 114 (22.6) 114 (22.6) Paulo H Werlang , Michael Horrigan , Luke T. Lavallée , Ilias Cagiannos ,
1
1
1
1
5-High 124 (24.7) 124 (24.7) Christopher G. Morash , Rodney H. Breau 1
1
6-Very-high 67 (13.3) 67 (13.3) 1 Urology, University of Ottawa, Ottawa, ON, Canada
Introduction: Patients on active surveillance for low-grade prostate can-
cer may receive prostate magnetic resonance imaging (MRI) as part of
Methods: A retrospective analysis of prostate cancer patients who under- routine followup or due to suspicion of an occult higher-grade lesion. In
went radical prostatectomy at UNMC between December 2007 and patients who underwent MRI and subsequently were treated with radical
November 2018 identified 503 and 75 patients who received either TRUS prostatectomy (RP), we aimed to determine if pre-prostatectomy prostate
or an MRI-fusion biopsy, respectively. Comparisons were made between biopsy was useful prior to treatment.
preoperative and postoperative NCCN risk stratification score, and the use Methods: As part of the prostate cancer Surgeon Report Card (SuRep)
of multivariable analysis (MVA) was used to assess the ability to preopera- study, we identified active surveillance patients who had an MRI prior to
tively predict NCCN Risk and adjust for potential demographic influences. RP. Based on clinical discretion, some patients received a post-MRI biopsy
Results: The mean age of the patients was 62 years and the mean prostate- prior to RP, while others did not. We compared pathologic outcomes
specific antigen (PSA) level was 9.3 ng/ml (Table 1). MRI-targeted biopsy between these groups.
correctly predicted post-RP NCCN risk stratification in 70.0% of patients Results: Between 2015 and 2019, 70 patients met inclusion criteria.
compared to 10.6% in the TRUS cohort (Table 2). When stratifying by Twenty-three (33%) received a prostate biopsy prior to RP. Of the biopsy
NCCN risk, the ability of TRUS to accurately predict NCCN risk ranged cohort, the PIRADS were ≤3, 4, and 5 in four (17%), 11 (48%), and
from 1.1–34.7%, with nearly all incorrect assessments being underpredic- eight (35%) patients, respectively. Corresponding PIRADS in the no-biopsy
tions. Conversely, accurate NCCN risk for MRI-targeted biopsy ranged cohort was six (13%), 11 (23%), and 30 (64%), respectively. In the biopsy
from 57.1–93.3%, with risk scores 3 and 4 showing slight over prediction cohort (n=23), only one (4%) had a post-MRI/pre-treatment biopsy with
UP-1.14. Table 2. NCCN risk stratification before and after radical prostatectomy
-4 -3 -2 -1 0 1 2 Total
TRUS # 6 37 98 307 53 2 0 503
% 1.19 7.36 19.48 61.03 10.54 0.4 0 100
MRI # 0 0 3 3 52 7 9 74
% 0 0 4.05 4.05 70.27 9.46 12.16 100
S48 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)