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Risk of Gleason Score 3 + 4 = 7 prostate cancer upgrading at radical prostatectomy is significantly reduced by target biopsy compared to standard biopsy technique.

BACKGROUND
To evaluate if multiparametric magnetic resonance (mpMRI)- transrectal ultrasound (TRUS) fusion targeted biopsy (TBx) versus untargeted standard biopsy (SBx) may decrease the rate of pathological upgrading of Gleason score (GS) 3+4 prostate cancer (PCa) at radical prostatectomy (RP). We also evaluated the impact of percent pattern 4 and cribriform glands at biopsy in the risk of GS 3 + 4 = 7 upgrading.


METHODS
301 patients with GS 3+4 PCa on biopsy (159 SBx and 142 TBx) who underwent laparoscopic robot-assisted RP were sequentially enrolled. Histological data from RP sections were used as reference standard. The concordance of biopsy with pathological GS, as well as the GS 3+4 upgrading at RP were evaluated in different univariate and multivariate binary logistic regression models, testing age, PSA, fPSA%, tumor volume, PI-RADS, clinical stage, percentage of Gleason pattern 4 (GP) and/or presence of cribriform sub-type at biopsy.


RESULTS
Of the 301 biopsies, the median of GP 4 was 16% of the tissue. Minimal GP 4 (≤ 16%) cancers had a significant lower median volume (1.7 ml) than those with GP4 >16% (2.9 ml), (p<0.001). Pathological GS 3+4 was confirmed for 58.8% and 82.2% for SBx and TBx patients, respectively. The rate of upgraded and downgraded GS on SBx versus TBx was 38.8% vs. 16.7% and 1.8% and 2.1%, respectively. The rate of upgrading was significantly associated with the presence of GP4 >16% versus ≤16% (OR 4.4, 95% CI 1.4-12.0; p=0.021) and with the presence of cribriform sub-type at biopsy specimens (OR 6.2, 95% CI 2.2-18.7; p<0.001).


CONCLUSIONS
We demonstrated that TBx technique significantly reduced the risk of GS 3+4 upgrading at RP, compared to SBx one. The rate of upgrading wassignificantly associated with GP4>16%, mostly when cribriform sub-type was present at biopsy specimens.