Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management
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...
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Elsevier
2025-02-01
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| Series: | European Urology Open Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168325000527 |
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| author | Riccardo Leni Emily A. Vertosick Nicole Liso Oguz Akin Sigrid V. Carlsson Francesco Montorsi Alberto Briganti James A. Eastham Samson W. Fine Andrew J. Vickers Behfar Ehdaie |
| author_facet | Riccardo Leni Emily A. Vertosick Nicole Liso Oguz Akin Sigrid V. Carlsson Francesco Montorsi Alberto Briganti James A. Eastham Samson W. Fine Andrew J. Vickers Behfar Ehdaie |
| author_sort | Riccardo Leni |
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| description | 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. |
| format | Article |
| id | doaj-art-6ef56cdeffbe4e06ad2cadc5f465ec2c |
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| publishDate | 2025-02-01 |
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| spelling | doaj-art-6ef56cdeffbe4e06ad2cadc5f465ec2c2025-08-20T02:14:54ZengElsevierEuropean Urology Open Science2666-16832025-02-0172465310.1016/j.euros.2025.01.012Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early ManagementRiccardo Leni0Emily A. Vertosick1Nicole Liso2Oguz Akin3Sigrid V. Carlsson4Francesco Montorsi5Alberto Briganti6James A. Eastham7Samson W. Fine8Andrew J. Vickers9Behfar Ehdaie10Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center New York NY USA; Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute Milan Italy; Vita-Salute San Raffaele University Milan Italy; Corresponding author. Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Tel. +39 02 2643 7453; Fax: +39 02 2643 2786.Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center New York NY USADepartment of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center New York NY USA; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center New York NY USADepartment of Radiology, Department of Surgery, Memorial Sloan Kettering Cancer Center New York NY USADepartment of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center New York NY USA; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center New York NY USA; Department of Urology, Sahlgrenska Academy at Gothenburg University Gothenburg Sweden; Department of Translational Medicine, Division of Urological Cancers Lund University Lund SwedenDivision of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute Milan Italy; Vita-Salute San Raffaele University Milan ItalyDivision of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute Milan Italy; Vita-Salute San Raffaele University Milan ItalyUrology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center New York NY USADepartment of Pathology, Memorial Sloan Kettering Cancer Center New York NY USADepartment of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center New York NY USAUrology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center New York NY USABackground 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.http://www.sciencedirect.com/science/article/pii/S2666168325000527Prostate cancerIntermediate riskMultiparametric magnetic resonance imagingConfirmatory biopsy |
| spellingShingle | Riccardo Leni Emily A. Vertosick Nicole Liso Oguz Akin Sigrid V. Carlsson Francesco Montorsi Alberto Briganti James A. Eastham Samson W. Fine Andrew J. Vickers Behfar Ehdaie Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management European Urology Open Science Prostate cancer Intermediate risk Multiparametric magnetic resonance imaging Confirmatory biopsy |
| title | Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management |
| title_full | Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management |
| title_fullStr | Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management |
| title_full_unstemmed | Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management |
| title_short | Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management |
| title_sort | confirmatory biopsy outcomes in patients with grade group 2 prostate cancer implications for early management |
| topic | Prostate cancer Intermediate risk Multiparametric magnetic resonance imaging Confirmatory biopsy |
| url | http://www.sciencedirect.com/science/article/pii/S2666168325000527 |
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