2017 CUA abstracts

CUAJ Editorial
2017 Canadian Urological Association Journal  
This is the first report of a multicentre, prospective, randomized phase 3 trial to determine if multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy can improve selection of patients eligible for active surveillance through improved detection of clinically significant cancer compared to systematic biopsy. The primary outcome was the proportion of subjects whose biopsy was upgraded at their confirmatory biopsy to Gleason score 7 (3 + 4) or higher. Methods: Eligible patients
more » ... e diagnosed with favourable-risk prostate cancer (Gleason 6 and prostate-specific antigen [PSA] <10) within the previous 12 months. 296 patients were registered and 273 randomized between systematic 12-core biopsy and an MRI, with targeted and systematic biopsies, done between six and 13 months after the initial biopsy. There were no differences between treatment arms in terms of stratum, demographics, tumour characteristics, or prior treatments. Results: 31 (23%) of transrectal ultrasound (TRUS)-guided biopsy patients had Gleason 7 or higher cancer compared with 29 (21.2%) of the MRIguided biopsy (p=0.68). Independent, blinded pathology review was performed on 188 patients. Upgrading incorporating path review occurred in 36/132 (27.3%) of TRUS-guided and 42/127 (33.1%) of MRI-guided biopsy patients (p=0.34). The positive predictive value (PPV) for Gleason 7 or higher cancer for Prostate Imaging Reporting and Data System (PI-RADS) score 1-2, 3,4, and 5 was 13%, 29%, 24%, and 33%, respectively. 2/12 (16.7%) with a MRI score of 1, and 3/33 (9%) with MRI score of 2 had Gleason 7 or higher cancers on systematic biopsy. The negative predic-tive value (NPV) of PI-RADS 1-2 for Gleason ≥7 was 89%. The results of targeted vs. systematic biopsy in the MRI arm is listed in Table 1 . Conclusions: No significant difference was observed in the rate of upgrading between confirmatory biopsy with TRUS compared with MRI-guided targeted biopsy. No secondary outcome was statistically significant. Performing confirmatory targeted biopsy only in men with a PI-RADS lesion ≥3 would identify 89% of Gleason 7 or greater cancers.
doi:10.5489/cuaj.4728 fatcat:73eow4zhrjakhofb3fihojpcfq