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Targeted Prostate Biopsy to Select Men for Active Surveillance: Do the Epstein Criteria Still Apply?

2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2014.02.005

1527-3792

Jim C. Hu, Edward Chang, Shyam Natarajan, Daniel Margolis, Malu Macairan, Patricia Lieu, Jiaoti Huang, Geoffrey A. Sonn, Frederick J. Dorey, Leonard S. Marks,

Urologic and reproductive health conditions

No AccessJournal of UrologyAdult Urology1 Aug 2014Targeted Prostate Biopsy to Select Men for Active Surveillance: Do the Epstein Criteria Still Apply? Jim C. Hu, Edward Chang, Shyam Natarajan, Daniel J. Margolis, Malu Macairan, Patricia Lieu, Jiaoti Huang, Geoffrey Sonn, Frederick J. Dorey, and Leonard S. Marks Jim C. HuJim C. Hu , Edward ChangEdward Chang , Shyam NatarajanShyam Natarajan , Daniel J. MargolisDaniel J. Margolis , Malu MacairanMalu Macairan , Patricia LieuPatricia Lieu , Jiaoti HuangJiaoti Huang , Geoffrey SonnGeoffrey Sonn , Frederick J. DoreyFrederick J. Dorey , and Leonard S. MarksLeonard S. Marks View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.005AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Established in 1994, the Epstein histological criteria (Gleason score 6 or less, 2 or fewer cores positive and 50% or less of any core) have been widely used to select men for active surveillance. However, with the advent of targeted biopsy, which may be more accurate than conventional biopsy, we reevaluated the likelihood of reclassification upon confirmatory rebiopsy using multiparametric magnetic resonance imaging-ultrasound fusion. Materials and Methods: We identified 113 men enrolled in active surveillance at our institution who met Epstein criteria and subsequently underwent confirmatory targeted biopsy via multiparametric magnetic resonance imaging-ultrasound fusion. Median patient age was 64 years, median prostate specific antigen was 4.2 ng/ml and median prostate volume was 46.8 cc. Targets or regions of interest on multiparametric magnetic resonance imaging-ultrasound fusion were graded by suspicion level and biopsied at 3 mm intervals along the longest axis (median 10.5 mm). Also, 12 systematic cores were obtained during confirmatory rebiopsy. Our reporting is consistent with START (Standards of Reporting for MRI-targeted Biopsy Studies) criteria. Results: Confirmatory fusion biopsy resulted in reclassification in 41 men (36%), including 26 (23%) due to Gleason grade 6 or greater and 15 (13%) due to high volume Gleason 6 disease. When stratified by suspicion on multiparametric magnetic resonance imaging-ultrasound fusion, the likelihood of reclassification was 24% to 29% for target grade 0 to 3, 45% for grade 4 and 100% for grade 5 (p = 0.001). Men with grade 4 and 5 vs lower grade targets were greater than 3 times more likely to be reclassified (OR 3.2, 95% CI 1.4–7.1, p = 0.006). Conclusions: Upon confirmatory rebiopsy using multiparametric magnetic resonance imaging-ultrasound fusion men with high suspicion targets on imaging were reclassified 45% to 100% of the time. Criteria for active surveillance should be reevaluated when multiparametric magnetic resonance imaging-ultrasound fusion guided prostate biopsy is used. References 1 : Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol2012; 62: 976. Google Scholar 2 : Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA1994; 271: 368. Crossref, Medline, Google Scholar 3 : Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol1989; 142: 71. 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Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHo M, Ross A and Eggener S (2023) Risk Stratification of Low-risk Prostate Cancer: Individualizing Care in the Era of Active SurveillanceJournal of Urology, Liss M, Newcomb L, Zheng Y, Garcia M, Filson C, Boyer H, Brooks J, Carroll P, Cooperberg M, Ellis W, Gleave M, Martin F, Morgan T, Nelson P, Wagner A, Thompson I and Lin D (2020) Magnetic Resonance Imaging for the Detection of High Grade Cancer in the Canary Prostate Active Surveillance StudyJournal of Urology, VOL. 204, NO. 4, (701-706), Online publication date: 1-Oct-2020.Bahler C, Green M, Hutchins G, Cheng L, Magers M, Fletcher J and Koch M (2019) Prostate Specific Membrane Antigen Targeted Positron Emission Tomography of Primary Prostate Cancer: Assessing Accuracy with Whole Mount PathologyJournal of Urology, VOL. 203, NO. 1, (92-99), Online publication date: 1-Jan-2020.Kornberg Z, Cowan J, Westphalen A, Cooperberg M, Chan J, Zhao S, Shinohara K and Carroll P (2019) Genomic Prostate Score, PI-RADS™ version 2 and Progression in Men with Prostate Cancer on Active SurveillanceJournal of Urology, VOL. 201, NO. 2, (300-307), Online publication date: 1-Feb-2019.Godtman R, Schafferer M, Pihl C, Stranne J and Hugosson J (2018) Long-Term Outcomes after Deferred Radical Prostatectomy in Men Initially Treated with Active SurveillanceJournal of Urology, VOL. 200, NO. 4, (779-785), Online publication date: 1-Oct-2018.Nassiri N, Margolis D, Natarajan S, Sharma D, Huang J, Dorey F and Marks L (2016) Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate CancerJournal of Urology, VOL. 197, NO. 3 Part 1, (632-639), Online publication date: 1-Mar-2017.Frye T, George A, Kilchevsky A, Maruf M, Siddiqui M, Kongnyuy M, Muthigi A, Han H, Parnes H, Merino M, Choyke P, Turkbey B, Wood B and Pinto P (2016) Magnetic Resonance Imaging-Transrectal Ultrasound Guided Fusion Biopsy to Detect Progression in Patients with Existing Lesions on Active Surveillance for Low and Intermediate Risk Prostate CancerJournal of Urology, VOL. 197, NO. 3 Part 1, (640-646), Online publication date: 1-Mar-2017.Recabal P, Assel M, Sjoberg D, Lee D, Laudone V, Touijer K, Eastham J, Vargas H, Coleman J and Ehdaie B (2016) The Efficacy of Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Risk Classification for Patients with Prostate Cancer on Active SurveillanceJournal of Urology, VOL. 196, NO. 2, (374-381), Online publication date: 1-Aug-2016.Felker E, Wu J, Natarajan S, Margolis D, Raman S, Huang J, Dorey F and Marks L (2015) Serial Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: Incremental ValueJournal of Urology, VOL. 195, NO. 5, (1421-1427), Online publication date: 1-May-2016.Satasivam P, Poon B, Ehdaie B, Vickers A and Eastham J (2015) Can Confirmatory Biopsy be Omitted in Patients with Prostate Cancer Favorable Diagnostic Features on Active Surveillance?Journal of Urology, VOL. 195, NO. 1, (74-79), Online publication date: 1-Jan-2016.Marks L (2015) Significance of Change in Gleason Grade in Patients on Active Surveillance for Prostate CancerJournal of Urology, VOL. 194, NO. 1, (8-9), Online publication date: 1-Jul-2015.Delongchamps N, Lefèvre A, Bouazza N, Beuvon F, Legman P and Cornud F (2014) Detection of Significant Prostate Cancer with Magnetic Resonance Targeted Biopsies—Should Transrectal Ultrasound-Magnetic Resonance Imaging Fusion Guided Biopsies Alone be a Standard of Care?Journal of Urology, VOL. 193, NO. 4, (1198-1204), Online publication date: 1-Apr-2015.Le J, Stephenson S, Brugger M, Lu D, Lieu P, Sonn G, Natarajan S, Dorey F, Huang J, Margolis D, Reiter R and Marks L (2014) Magnetic Resonance Imaging-Ultrasound Fusion Biopsy for Prediction of Final Prostate PathologyJournal of Urology, VOL. 192, NO. 5, (1367-1373), Online publication date: 1-Nov-2014. Volume 192Issue 2August 2014Page: 385-390 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsmagnetic resonance imagingprostatic neoplasmsprostateultrasonographypatient selectionMetricsAuthor Information Jim C. Hu More articles by this author Edward Chang More articles by this author Shyam Natarajan More articles by this author Daniel J. Margolis More articles by this author Malu Macairan More articles by this author Patricia Lieu More articles by this author Jiaoti Huang More articles by this author Geoffrey Sonn More articles by this author Frederick J. Dorey More articles by this author Leonard S. Marks More articles by this author Expand All Advertisement PDF downloadLoading ...