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Comparison of TRUS and Combined MRI Targeted plus Systematic Prostate Biopsy for the Concordance Between Biopsy and Radical Prostatectomy Pathology
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  • Guven Aslan,
  • Serdar Çelik,
  • Sinan Sözen,
  • Bulent Akdogan,
  • Volkan Izol,
  • Cenk Yucel Bilen,
  • Bahadır Şahin,
  • Levent Turkeri,
  • Members of Urooncology Association Study Group
Guven Aslan
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Serdar Çelik
Izmir Bozyaka Training and Research Hospital
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Sinan Sözen
Gazi University
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Bulent Akdogan
Hacettepe University
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Volkan Izol
Cukurova University Faculty of Medicine
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Cenk Yucel Bilen
Hacettepe University
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Bahadır Şahin
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Levent Turkeri
Acibadem University
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Members of Urooncology Association Study Group
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Abstract

Aim: To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing conventional 12-core TRUS-Bx at radical prostatectomy specimens (RP). Methods: Consecutive patients diagnosed prostate cancer (127 with combination of both targeted biopsy (TBx) plus systematic biopsies (SBx) and separate patient cohort of 330 conventional TRUS-Bx without mpMRI) with a PSA level of <20 ng/ml prior to RP were included. The primary end point was the grade group concordance between biopsy and RP pathology according to biopsy technique. Results: Clinically significant prostate cancer detection was 51.2 % for TRUS-Bx, 49.5 % for SBx, 67% for TBx and 75.7% for TBx+SBx . Upgrading and downgrading of at least one Gleason Grade Group (GGG) was recorded in 43.3% / 6.7% patients of the TRUS-Bx, and in 20.5% / 22 % of the TBX+SBx group, respectively (all p<0.001). Concordance level was detected to be significantly higher for ISUP 1 in combined TBx + SBx method compared to conventional TRUS-Bx (61.3% vs 37.9%, p=0.014). In ISUP 1 exclusively, significant upgrading was seen in TRUS-Bx (62.1%) when compared to TBx (41.4%) and TBx+SBx (38.7%). Conclusions: MRI-targeted biopsies detected more significant PCa than TRUS-Bx but, superiority in significant cancer detection appears as a result of inadvertant selective sampling of small higher grade areas. within an otherwise low grade cancer and does not reflect accurate GGG final surgical pathology. TBx+SBx has the greatest concordance in ISUP Grade 1 with less upgrading which is utmost important for active surveillance.

Peer review status:Published

30 Sep 2020Submitted to International Journal of Clinical Practice
01 Oct 2020Submission Checks Completed
01 Oct 2020Assigned to Editor
04 Oct 2020Reviewer(s) Assigned
12 Oct 2020Review(s) Completed, Editorial Evaluation Pending
17 Oct 20201st Revision Received
19 Oct 2020Submission Checks Completed
19 Oct 2020Assigned to Editor
19 Oct 2020Reviewer(s) Assigned
23 Oct 2020Review(s) Completed, Editorial Evaluation Pending
23 Oct 2020Editorial Decision: Accept
20 Nov 2020Published in International Journal of Clinical Practice. 10.1111/ijcp.13797