A total of 3,167 patients diagnosed with prostate cancer by systematic biopsy without a history of a previous mpMRI were identified at a single tertiary care referral Center between 2010 and 2018. The authors then identified 299 patients with prostate cancer, who were diagnosed with an upfront mpMRI and subsequently underwent a targeted biopsy combined with a systematic biopsy. The authors performed multivariable logistic regression analyses to predict the risk of having clinically significant prostate cancer in the two groups of patients, after adjusting for age, PSA, clinical stage (T1 vs T2 vs T3) and year of biopsy. In the next step, the authors investigated the trend of the probability of the group of patients that did not undergo a mpMRI to harbor clinically significant prostate cancer over time as compared to patients that did undergo a mpMRI.
Table 1 – Clinical characteristics of the patients:
Table 1 demonstrates the clinical characteristics of the patients analyzed. Figure 1 demonstrates that the rate of Gleason score 3+3 decreased from 55.0% in 2010 to 12.9% in 2018 in the non-MRI group (p<0.001; figure 1a). In contrast, the rate of GS≥4+3 increased from 19% in 2010 to 57% in 2018 (p<0.001; Figure 1a). The multivariable analysis demonstrated that age (OR: 1.05), PSA (OR:1.04), clinical stage (OR T2: 2.26; T3: 6.02) and biopsy year (OR:1.21) were all associated in a statistically significant manner with the probability to harbour clinically significant prostate cancer (all p<0.001). The probability of clinically significant cancer increased over time from 15% in 2010 to roughly 45% in 2018 in men not receiving any MRI (Figure 1b). The graph also showed a comparable trend in the mpMRI group (Figure 1b) where men referred to undergo a mpMRI are at even higher risk of clinically significant cancer, regardless of imaging findings.
Table 2 – Multivariable analysis predicting clinically significant prostate cancer:
In conclusion, the rate of GS 3+3 in patients referred for systematic biopsy without a previous MRI has decreased over time, while a significant increase of GS≥4+3 was observed. Interestingly, in both groups a substantial increase in the detection of clinically significant prostate cancer was observed. These data suggest that there is an improved patient selection over time by physicians who are currently referring patients to both imaging-guided and systematic biopsies. In general, the authors conclude that more aggressive disease is being diagnosed over time.
Figure 1a – Trend over time of Gleason score detected at systematic biopsy in the non-MRI group 1b – Comparison of clinically significant prostate cancer in the non-MRI and MRI group:
Presented by: Armando Stabile, MD, Scientific Institute for Research and Healthcare IRCCS, Ospedale San Raffaele, Division of Oncology, Unit of Urology, Milan, Italy
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.