Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer : Implications for Early Management
(2025) In European Urology Open Science 72. p.46-53- Abstract
Background and objective: Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx. Methods: This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on... (More)
Background and objective: Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx. Methods: This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on initial Bx, and prostate-specific antigen (PSA) density. Key findings and limitations: Among 301 patients, 62 (21%) were downgraded to GG 1 and 23 (8%) had no cancer on cBx. For patients with nonsuspicious MRI findings (PI-RADS 1–3; n = 123), the probability of having no pattern 4 on CBx was 34%, 20%, and 11% for 1, 2, and 3 mm of pattern 4 at initial Bx. For PI-RADS 4–5 without EPE on MRI (n = 146), the corresponding probabilities were 18%, 10%, and 5%. Patients with EPE on MRI (n = 32) had low probability (<10%) of having no pattern 4 on cBx irrespective of pattern 4 on initial Bx. Results using a model based on PSA density followed a similar trend. After applying the model in a cohort of patients with GG 2 cancer who immediately underwent surgery (n = 2275), we estimated that two-thirds would be eligible for cBx before treatment using a probability threshold of 5–10% for avoiding immediate surgery. Conclusions and clinical implications: Patients with GG 2 prostate cancer, no evidence of EPE, and a few millimeters of pattern 4 should undergo cBx before proceeding to surgery. Further research should define the oncologic risk for such patients, refine the criteria for cBx in GG 2 disease, and assess methods for quantifying pattern 4 length in MRI-targeted cores. Patient summary: For patients with grade group (GG) 2 prostate cancer, we found that the amount of Gleason pattern 4 cancer in the initial biopsy, PSA (prostate-specific antigen) density, and MRI (magnetic resonance imaging) findings help to identify men who are likely to be downgraded to less aggressive GG 1 cancer or no cancer at all on a repeat confirmatory biopsy. We assessed these predictors in a group of patients with similar characteristics who underwent immediate surgery, and found that approximately two-thirds would benefit from a confirmatory biopsy.
(Less)
- author
- organization
- publishing date
- 2025-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Confirmatory biopsy, Intermediate risk, Multiparametric magnetic resonance imaging, Prostate cancer
- in
- European Urology Open Science
- volume
- 72
- pages
- 8 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85217418709
- ISSN
- 2666-1691
- DOI
- 10.1016/j.euros.2025.01.012
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025 The Author(s)
- id
- 2ca3ddf1-16d8-4db2-adda-393daac3757f
- date added to LUP
- 2025-04-09 09:46:42
- date last changed
- 2025-04-09 09:47:19
@article{2ca3ddf1-16d8-4db2-adda-393daac3757f,
abstract = {{<p>Background and objective: Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx. Methods: This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on initial Bx, and prostate-specific antigen (PSA) density. Key findings and limitations: Among 301 patients, 62 (21%) were downgraded to GG 1 and 23 (8%) had no cancer on cBx. For patients with nonsuspicious MRI findings (PI-RADS 1–3; n = 123), the probability of having no pattern 4 on CBx was 34%, 20%, and 11% for 1, 2, and 3 mm of pattern 4 at initial Bx. For PI-RADS 4–5 without EPE on MRI (n = 146), the corresponding probabilities were 18%, 10%, and 5%. Patients with EPE on MRI (n = 32) had low probability (<10%) of having no pattern 4 on cBx irrespective of pattern 4 on initial Bx. Results using a model based on PSA density followed a similar trend. After applying the model in a cohort of patients with GG 2 cancer who immediately underwent surgery (n = 2275), we estimated that two-thirds would be eligible for cBx before treatment using a probability threshold of 5–10% for avoiding immediate surgery. Conclusions and clinical implications: Patients with GG 2 prostate cancer, no evidence of EPE, and a few millimeters of pattern 4 should undergo cBx before proceeding to surgery. Further research should define the oncologic risk for such patients, refine the criteria for cBx in GG 2 disease, and assess methods for quantifying pattern 4 length in MRI-targeted cores. Patient summary: For patients with grade group (GG) 2 prostate cancer, we found that the amount of Gleason pattern 4 cancer in the initial biopsy, PSA (prostate-specific antigen) density, and MRI (magnetic resonance imaging) findings help to identify men who are likely to be downgraded to less aggressive GG 1 cancer or no cancer at all on a repeat confirmatory biopsy. We assessed these predictors in a group of patients with similar characteristics who underwent immediate surgery, and found that approximately two-thirds would benefit from a confirmatory biopsy.</p>}},
author = {{Leni, Riccardo and Vertosick, Emily A. and Liso, Nicole and Akin, Oguz and Carlsson, Sigrid V. and Montorsi, Francesco and Briganti, Alberto and Eastham, James A. and Fine, Samson W. and Vickers, Andrew J. and Ehdaie, Behfar}},
issn = {{2666-1691}},
keywords = {{Confirmatory biopsy; Intermediate risk; Multiparametric magnetic resonance imaging; Prostate cancer}},
language = {{eng}},
pages = {{46--53}},
publisher = {{Elsevier}},
series = {{European Urology Open Science}},
title = {{Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer : Implications for Early Management}},
url = {{http://dx.doi.org/10.1016/j.euros.2025.01.012}},
doi = {{10.1016/j.euros.2025.01.012}},
volume = {{72}},
year = {{2025}},
}