title: The role of MRI-targeted and confirmatory biopsies for cancer upstaging at selection in patients considered for active surveillance for clinically low-risk prostate cancer.
abstract: OBJECTIVE
  The purpose of this study was to assess the roles of MRI-targeted biopsies (TB) and confirmatory biopsies for cancer upstaging at selection in patients considered for active surveillance (AS) for low-risk prostate cancer (PCa) based on the first systematic biopsy (SB) series in another centre.
  
  
  METHODS
  From 2009 to 2012, 41 patients with PCa diagnosed within the last 4 months and eligible for AS [clinical stage ≤T2a, prostate-specific antigen (PSA) <10 ng/ml, ≤2 positive biopsy cores with no Gleason pattern 4 or 5 and ≤5 mm involvement of any biopsy core] underwent pre-biopsy MRI, confirmatory transrectal ultrasound 12-core SB and MRI-TB of suspicious lesions. A contingency table assessed the accuracy of MRI to predict cancer upstaging.
  
  
  RESULTS
  Median age and PSA were 63.5 years and 5.3 ng/ml, respectively. Overall, 24 patients (59 %) were upstaged. This upstaging was obtained at a confirmatory SB in 16 patients (39 %) based on the Gleason score (9), on cancer length (8) or both (7) and at MRI-TB in 17 patients (41 %) based on the Gleason score (14), cancer length (9) or both (6). Nine patients were upstaged at both SB and TB (22 %). The added value of MRI-TB was 20 % (8/41). The positive and negative predictive values of MRI for predicting cancer upstaging were 79 and 70.5 %, respectively.
  
  
  CONCLUSIONS
  MRI-TB and confirmatory SB upstaged 59 % of cases, improving the selection of patients considered for AS at the first series of SB. Variation in histologic grade assignation between centres and better cancer sampling may explain this high upstaging rate.
authors.affiliation: Department of Urology, CHU Lille, Univ Lille Nord de France, 59000, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Marliere
authors.forename: Philippe
authors.initials: P
authors.lastname: Puech
authors.forename: Ahmed
authors.initials: A
authors.lastname: Benkirane
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.forename: Laurent
authors.initials: L
authors.lastname: Lemaitre
authors.forename: Xavier
authors.initials: X
authors.lastname: Leroy
authors.forename: Nacim
authors.initials: N
authors.lastname: Betrouni
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018579:Patient Selection; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors