Image-guided approaches improve the diagnostic yield of prostate biopsy and frequently modify estimates of clinical risk. To better understand the impact of MRI-ultrasound fusion prostate biopsy (MRF-TB) on risk assessment, we compared the distribution of National Comprehensive Cancer Network (NCCN) risk groupings as calculated from both MRF-TB and systematic biopsy (SB) alone.
We performed a retrospective analysis of 713 patients who underwent MRF-TB from January 2017 to July 2021. The primary study objective was to compare the distribution of NCCN risk groupings obtained using MRF-TB (systematic + targeted) vs SB.
SB alone classified 10% and 18.7% as very-low and low risk, respectively, while MRF-TB classified 10.5% and 16.1% as very-low and low risk. Among men with benign, low, and favorable-intermediate-risk disease on SB alone, 4.6% were reclassified as high and very high-risk on MRF-TB. Of 207 patients electing active surveillance as management, 64 (31%), 91 (44%), 42 (20.2%), and 10 (4.8%) were classified as very-low, low, and favorable-intermediate and unfavorable-intermediate risk criteria, respectively. When utilizing SB alone, 204 patients (28.7%) were classified as having combined very low and low NCCN risk, while 190 men (26.6%) received this classification when using MRF-TB.
Addition of MRF-TB to SB might change eligibility for active surveillance in only a small proportion of patients with prostate cancer. Our findings support the need for routine use of quantitative risk assessment over risk groupings to promote more nuanced decision-making for localized cancer.
JNCI cancer spectrum. 2023 Dec 12 [Epub ahead of print]
Ghazal Khajir, Benjamin Press, Soum Lokeshwar, Kamyar Ghabili, Syed Rahman, Mursal Gardezi, Samuel Washington, Matthew R Cooperberg, Preston Sprenkle, Michael S Leapman
Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA., Department of Radiology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA., Department of Urology, University of California San Francisco, San Francisco, California, USA.