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Hagens MJ, Ribbert LLA, Jager A, Veerman H, Barwari K, Boodt B, de Bruijn RE, Claessen A, Leter MR, van der Noort V, Smeenge M, Roeleveld TA, Rynja SP, Schaaf M, Weltings S, Vis AN, Bekers E, van Leeuwen PJ, van der Poel HG. Histopathological concordance between prostate biopsies and radical prostatectomy specimens-implications of transrectal and transperineal biopsy approaches. Prostate Cancer Prostatic Dis 2024; 27:312-317. [PMID: 37660218 DOI: 10.1038/s41391-023-00714-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the histopathological concordance rates between prostate biopsies and radical prostatectomy specimens according to the applied biopsy approach (transrectal or transperineal). METHODS We studied patients who had been newly diagnosed with clinically significant prostate cancer and who underwent a radical prostatectomy between 2018 and 2022. Patients were included if they underwent a prebiopsy magnetic resonance imaging and if they had not been previously treated for prostate cancer. Histopathological grading on prostate biopsies was compared with that on radical prostatectomy specimens. Univariable and multivariable logistic regression analyses were performed to assess the effect of the applied biopsy approach on histopathological concordance. Additional analyses were performed to assess the effect of the applied biopsy approach on American Urological Association risk group migration, defined as any change in risk group after radical prostatectomy. RESULTS In total, 1058 men were studied, of whom 49.3% (522/1058) and 50.7% (536/1058) underwent transrectal and transperineal prostate biopsies, respectively. Histopathological disconcordance was observed in 37.8% (400/1058) of men while American Urological Association risk group migration was observed in 30.2% (320/1058) of men. A transperineal biopsy approach was found to be independently associated with higher histopathological concordance rates (OR 1.33 [95% CI 1.01-1.75], p = 0.04) and less American Urological Association risk group migration (OR 0.70 [95% CI 0.52-0.93], p = 0.01). CONCLUSIONS The use of a transperineal biopsy approach improved histopathological concordance rates compared to the use of a transrectal biopsy approach. A transperineal biopsy approach may provide more accurate risk stratification for clinical decision-making. Despite recent improvements, histopathologic concordance remains suboptimal and should be considered before initiating management.
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Affiliation(s)
- M J Hagens
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands.
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands.
| | - L L A Ribbert
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - A Jager
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - H Veerman
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - K Barwari
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Andros Clinics, Amsterdam, the Netherlands
| | - B Boodt
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Flevoziekenhuis, Almere, the Netherlands
| | - R E de Bruijn
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Ziekenhuis Amstelland, Amstelveen, the Netherlands
| | - A Claessen
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | - M R Leter
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - V van der Noort
- Department of Statistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Smeenge
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, St Jansdal Ziekenhuis, Harderwijk, the Netherlands
| | - T A Roeleveld
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - S P Rynja
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - M Schaaf
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, BovenIJ Ziekenhuis, Amsterdam, the Netherlands
| | - S Weltings
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Zaans Medisch Centrum, Zaandam, the Netherlands
| | - A N Vis
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - E Bekers
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - P J van Leeuwen
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
| | - H G van der Poel
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
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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] [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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3
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Hyun CL, Park KK. The feasibility of distance to the tumor of biopsy cores to estimate the extracapsular extension. Prostate Int 2023; 11:233-238. [PMID: 38196557 PMCID: PMC10772149 DOI: 10.1016/j.prnil.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 01/11/2024] Open
Abstract
Background To investigate the predictive capability of a new parameter, the distance between the fibromuscular capsule and the tumor as measured using a prostate biopsy core (referred to as "distance to the tumor" [DTT]), for the presence of extracapsular extension (ECE). Materials and methods We analyzed specimens obtained from 246 patients diagnosed with prostate cancer. All patients underwent prebiopsy, prostate magnetic resonance imaging (MRI), and subsequent prostatectomy. DTT measurements were obtained for each prostate biopsy core, and the minimum (min) DTT was extracted. We assessed the relationship between min DTT, MRI-estimated ECE, and pathological ECE, considering factors such as the PI-RADS score and tumor location. Results In this study of 246 patients, the mean age was 65.8 years, and the mean prostate-specific antigen (PSA) level was 18.9 ng/ml. Patients with suspicious lesions in the peripheral zone and pathological ECE displayed higher rates of positive digital rectal examination (DRE), elevated PSA levels, and shorter DTT values in the biopsy cores. DTT demonstrated an accurate estimation of the presence of ECE, similar to MRI findings. Min DTT exhibited higher accuracy for peripheral zone masses, with a cutoff value of 1.0 mm for min DTT predicting ECE (AUC: 0.84, sensitivity: 72.23%, specificity: 77.78%, P < 0.01). Of the 246 patients, 66 had no ECE on MRI; however, 18 of these patients displayed pathological ECE, with 14 having DTT values <1.0 mm. Conclusions Min DTT, positive DRE results, and a higher Gleason grade were significantly associated with ECE. DTT measurements of <1 mm can provide a more accurate prediction of ECE in the peripheral zone of the prostate than MRI-based assessments.
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Affiliation(s)
- Chang Lim Hyun
- Department of Pathology, School of Medicine, Jeju National University, Jeju, Korea
| | - Kyung Kgi Park
- Department of Urology, School of Medicine, Jeju National University, Jeju, Korea
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Cano Garcia C, Wenzel M, Piccinelli ML, Hoeh B, Landmann L, Tian Z, Humke C, Incesu RB, Köllermann J, Wild PJ, Würnschimmel C, Graefen M, Tilki D, Karakiewicz PI, Kluth LA, Chun FKH, Mandel P. External Tertiary-Care-Hospital Validation of the Epidemiological SEER-Based Nomogram Predicting Downgrading in High-Risk Prostate Cancer Patients Treated with Radical Prostatectomy. Diagnostics (Basel) 2023; 13:diagnostics13091614. [PMID: 37175005 PMCID: PMC10178748 DOI: 10.3390/diagnostics13091614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/06/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
We aimed to externally validate the SEER-based nomogram used to predict downgrading in biopsied high-risk prostate cancer patients treated with radical prostatectomy (RP) in a contemporary European tertiary-care-hospital cohort. We relied on an institutional tertiary-care database to identify biopsied high-risk prostate cancer patients in the National Comprehensive Cancer Network (NCCN) who underwent RP between January 2014 and December 2022. The model's downgrading performance was evaluated using accuracy and calibration. The net benefit of the nomogram was tested with decision-curve analyses. Overall, 241 biopsied high-risk prostate cancer patients were identified. In total, 51% were downgraded at RP. Moreover, of the 99 patients with a biopsy Gleason pattern of 5, 43% were significantly downgraded to RP Gleason pattern ≤ 4 + 4. The nomogram predicted the downgrading with 72% accuracy. A high level of agreement between the predicted and observed downgrading rates was observed. In the prediction of significant downgrading from a biopsy Gleason pattern of 5 to a RP Gleason pattern ≤ 4 + 4, the accuracy was 71%. Deviations from the ideal predictions were noted for predicted probabilities between 30% and 50%, where the nomogram overestimated the observed rate of significant downgrading. This external validation of the SEER-based nomogram confirmed its ability to predict the downgrading of biopsy high-risk prostate cancer patients and its accurate use for patient counseling in high-volume RP centers.
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Affiliation(s)
- Cristina Cano Garcia
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC H2X 0A9, Canada
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
| | - Mattia Luca Piccinelli
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC H2X 0A9, Canada
- Department of Urology, IEO European Institute of Oncology, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
| | - Lea Landmann
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC H2X 0A9, Canada
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
| | - Reha-Baris Incesu
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC H2X 0A9, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
- LOEWE Center Frankfurt Cancer Institute (FCI), Goethe University Frankfurt, 60439 Frankfurt am Main, Germany
| | | | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Urology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC H2X 0A9, Canada
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, 39120 Frankfurt am Main, Germany
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