Targeted Biopsy is Sufficient for Men on Active Surveillance for Early-Stage Prostate Cancer

No AccessJournal of UrologyOriginal Clinical Article9 Oct 2024Targeted Biopsy is Sufficient for Men on Active Surveillance for Early-Stage Prostate Cancer Mary O. Fakunle, Janet E. Cowan, Samuel L. Washington, Katsuto Shinohara, Hao G. Nguyen, and Peter R. Carroll Mary O. FakunleMary O. Fakunle Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California , Janet E. CowanJanet E. Cowan https://orcid.org/0000-0003-1852-8260 Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California , Samuel L. WashingtonSamuel L. Washington Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California , Katsuto ShinoharaKatsuto Shinohara Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California , Hao G. NguyenHao G. Nguyen Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California , and Peter R. CarrollPeter R. Carroll Corresponding Author: Peter R. Carroll, MD, MPH, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, Box 1695, San Francisco, CA 94143 ( ([email protected]) ). View All Author Informationhttps://doi.org/10.1097/JU.0000000000004265AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Serial biopsy is a mainstay for patients on active surveillance (AS) for prostate cancer. mpMRI targeting has become a standard. It is unclear whether targeted biopsy alone reliably identifies the dominant lesion, thereby obviating the need for systematic sampling. Materials and Methods: Participants enrolled in AS with early-stage prostate cancer (PSA < 20, cT1-2, GG1-2) and underwent 2+ systematic biopsy sessions with or without MR-targeted sampling. Findings for dominant Gleason Grade (GG) and tumor localization were assessed. Results: Among 821 men who underwent MR fusion biopsies, 82% were diagnosed with GG1 and 18% with GG2. Sixty-two percent had their first MR fusion biopsy as diagnostic or confirmatory. Across all fusion biopsies, MRI-targeted detection of GG and/or tumor location overlapped with systematic sampling for 95% of cases. For 5% of cases, systematic biopsy was unique in detecting GG and location outside the target. Most unique lesions detected outside the target had marginally aggressive features: 73% GG2 of low volume and favorable histologic subtypes. Conclusions: In men with MR-fusion biopsies, targeting alone identified the dominant GG and location most of the time (95%); 25% of dominant lesions were contiguous to the target suggesting that better sampling of the target improves detection. The remaining 5% of men had higher grade, low volume disease outside the targeted lesion of which only 2% had aggressive risk features. MR fusion targeting, without systematic sampling, may be sufficient to monitor men on AS. Few high risk cancers are missed, all of limited volume and favorable histology. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsprostate canceractive surveillancetargeted biopsysystematic biopsyMR fusionMetrics Author Information Mary O. Fakunle Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California More articles by this author Janet E. Cowan Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California More articles by this author Samuel L. Washington Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California More articles by this author Katsuto Shinohara Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California More articles by this author Hao G. Nguyen Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California More articles by this author Peter R. Carroll Corresponding Author: Peter R. Carroll, MD, MPH, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, Box 1695, San Francisco, CA 94143 ( ([email protected]) ). More articles by this author Expand All Advertisement PDF downloadLoading ...