Prostate cancer (PC) heterogeneity can result in sampling discrepancies during biopsy, leading to inaccurate molecular classifications that affect treatment decisions. We evaluated transcriptomic profile variability between multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) and systematic biopsy (SBx) methods using the Decipher GRID platform.
The study included 205 men from the MAST trial. We analyzed 408 biopsy samples, of which 149 were TBx and 259 were SBx samples. Three prognostic signatures-the Decipher genomic classifier (DGC), cell cycle progression (CCP), and Genomic Prostate Score-were assessed in relation to grade group (GG) and MRI phenotype. Multivariable linear regression was conducted to adjust for the confounding effects of GG and tumor purity.
Unpaired analysis revealed that TBx samples had higher derived GPS and CCP scores than SBx samples (p < 0.05), but the difference was no longer significant after multiple-test adjustment. There was no significant difference in scores between SBx and TBx samples in the subgroup with GG 1 disease. For TBx cores, higher genomic scores were associated with higher Prostate Imaging-Reporting and Data System (PI-RADS) scores in the overall cohort, but not in the GG 1 subgroup. Multivariable analysis revealed significant associations between DGC and CCP scores and PI-RADS scores (p < 0.01). Higher DGC score concordance between TBx and SBx lesions was observed in the low-risk subgroup. A limitation of the study is the small sample size, so further validation is required.
TBx samples yield higher genomic scores than SBx samples, with grade influencing the association between PI-RADS score and genomic risk. For the GG 1 subgroup, there was no correlation between PI-RADS and genomic scores. These findings need further validation to assess the impact of TBx on genomic risk assessment in active surveillance.
We examined the effectiveness of two different biopsy methods in assessing the risk of prostate cancer (PC) progression. We found that while biopsy samples guided by MRI (magnetic resonance imaging) scans often showed higher genetic risk scores than biopsy samples without MRI guidance, the difference was not significant for men with lower-grade PC. Our findings suggest that MRI targeting for biopsy might not always provide additional information about cancer aggressiveness for patients with low-risk PC.
European urology focus. 2024 Dec 10 [Epub ahead of print]
Tarek Ajami, Hui Yu, Joao G Porto, Nachiketh Soodana Prakash, Adam Williams, Yuval Avda, Ankur Malpani, Dinno F Mendiola, Pedro F S Freitas, Archan Khandekar, Sanjaya Swain, Sandra Gaston, Brandon Mahal, Elena Cortizas, Zoe Szczotka, Timothy Gerard, Bruce Kava, Radka Stoyanova, Oleksandr N Kryvenko, Patricia Castillo, Chad R Ritch, Bruno Nahar, Mark L Gonzalgo, Alan Pollack, Dipen J Parekh, Sanoj Punnen
Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA; Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain. Electronic address: ., Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, Miami, FL, USA., Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA., Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, USA., Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA., Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA.