Introduction
Twelve core transrectal ultrasound guided prostate biopsy (TRUS-Bx) is
the most commonly used method for the diagnosis of prostate cancer
(PCa). However, it may be hampered by several limitations such as not
being targeted and not fully anatomical systematic biopsy method when we
look at the magnetic resonance imaging (MRI) studies (1-3). This method
is also shown to be associated with missed diagnosis of PCa,
misclassification of cancer grade and high upgrading and downgrading
levels after RP (4,5). Upgrading can in fact lead to inappropriate or
under-treatment in a subgroup of patients. A more accurate diagnostic
method is crucial to avoid misclassification, which is particularly
important in appropriate decision-making for the treatment of PCa such
as active surveillance or other therapies. Prior researches have shown
that multiparametric MRI targeted biopsy identifies clinically
significant prostate cancers more accurately than conventional
systematic biopsy in men with suspected localized prostate cancer (6-9).
Despite the improved detection of clinically significant cancers with
MRI targeted biopsies, debate persists about whether MRI targeted biopsy
better predicts final pathology at radical prostatectomy (10, 11). The
MRI targeted biopsy results in the previous studies reported that
targeted biopsies have a higher rate of concordance level with the RP
compared to systematic biopsy (6-8, 12-14). However, there is limited
data comparing to head to head concordance, upgrading and downgrading
between conventional TRUS-Bx and MRI Fusion biopsies according to ISUP
grade groups. Whether MRI/US image fusion biopsy techniques better
correlate with final histopathologic outcomes by reducing Gleason Score
misclassifications deserves further evaluation.
In this context we aimed to analyze the ISUP Gleason group grading
concordance between prostatectomy and biopsy stratiļ¬ed by the approach
of biopsy technique (TBx+SBx vs TRUS-Bx). Optimal agreement between
biopsy and surgical Gleason Score among three biopsy schemes TBx alone
vs SBx alone vs combined TBx + SBx is also investigated.