Risk of adverse pathology at prostatectomy in the era of MRI and targeted biopsies; rethinking active surveillance for intermediate risk prostate cancer patients.

Autor: Bloom JB; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Daneshvar MA; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Lebastchi AH; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Ahdoot M; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Gold SA; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Hale G; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Mehralivand S; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany., Sanford T; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD., Valera V; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Wood BJ; Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD., Choyke PL; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD., Merino MJ; Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD., Turkbey B; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD., Parnes HL; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD., Pinto PA; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany. Electronic address: pintop@mail.nih.gov.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2021 Oct; Vol. 39 (10), pp. 729.e1-729.e6. Date of Electronic Publication: 2021 Mar 16.
DOI: 10.1016/j.urolonc.2021.02.018
Abstrakt: Purpose: Men with intermediate risk (IR) prostate cancer (CaP) are often excluded from active surveillance (AS) due to higher rates of adverse pathology (AP). We determined our rate of AP in men who underwent multiparametric MRI (MpMRI) with combined biopsy (CB) consisting of targeted biopsy (TB) and systematic biopsy (SB) prior to radical prostatectomy (RP).
Methods: A retrospective review was conducted of men with Gleason Grade Group (GG) 2 disease who underwent RP after SB alone or after preoperative MRI with CB. AP was defined as either pathologic stage T3a (AP ≥ T3a) or pathologic stage T3b (AP ≥ T3b) and/or GG upgrading. Rates of AP were determined for both groups and those who fit the National Comprehensive Cancer Network (NCCN) definition of favorable IR (FIR) or the low volume IR (LVIR) criteria. Multivariable logistic regression was used to determine predictive factors.
Results: The overall rate of AP ≥ T3b was 21.2% in the SB group vs. 8.6% in the MRI with CB group, P = 0.006. This rate was lowered to 6.8% and 5.6% when men met the definition of NCCN FIR or LVIR, respectively. Suspicion for extraprostatic extension (EPE) (OR 7.65, 95% CI 1.77-33.09, P = 0.006) and positive cores of GG 2 on SB (OR 1.43, 95% CI 1.05-1.96, P = 0.023) were significant for predicting AP ≥ T3b.
Conclusions: Rates of AP at RP after MRI with CB are lower than studies prior to the adoption of this technology, suggesting that more men with IR disease may be considered for AS. However, increasing cores positive on SB and MRI findings suggestive of EPE remain unsafe.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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