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 stratified 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.