Additional elastography-targeted biopsy improves the agreement between biopsy Gleason grade and Gleason grade at radical prostatectomy.
OBJECTIVE
To assess whether real-time elastography-targeted biopsy (RTE-bx) may help to correctly assign Gleason grade at radical prostatectomy (RP) and to compare discriminant properties of systematic biopsy alone (sbx) versus combination with RTE-bx (comb-bx) to distinguish between postoperatively favorable (Gleason 3 + 3, pT2, Nx/0) and postoperatively unfavorable (Gleason ≥4 + 4) prostate cancer (PCa) at RP.


METHODS
Overall, 259 patients diagnosed with PCa at systematic biopsy in combination with RTE-bx underwent RP between 2008 and 2011. Gleason Score derived from sbx versus comb-bx was compared to the gold-standard RP, and discriminant properties were assessed. Specificity gains were examined for sbx versus comb-bx when the endpoint consisted of postoperatively favorable PCa at RP. Sensitivity gains were examined, when analyses focused on postoperatively unfavorable PCa.


RESULTS
Comb-bx resulted in higher correct overall Gleason assignment (68.3 vs. 56.7 %, p = 0.008) than sbx. Similarly, lower rates of undergrading (21.2 vs. 36.3 %, p < 0.001) were recorded. Specificity gains with comb-bx were 10 % (92 vs. 82 %, p = 0.004) for postoperatively favorable PCa. Comb-bx resulted in 31 % sensitivity gains relative to sbx (94 vs. 63 %, p = 0.03), when postoperatively unfavorable PCa was the endpoint.


CONCLUSIONS
The agreement between biopsy and pathology Gleason Score was significantly higher for comb-bx than sbx. Additionally, comb-bx reduced the rate of false positives in the diagnosis of favorable PCa. Rates of correctly classified unfavorable PCa at RP were also higher for comb-bx. Those data indicate that comb-bx is useful in clinical practice.
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. boehm@martini-klinik.de.|Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada. boehm@martini-klinik.de.
Katharina
K
Boehm
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Pierre
P
Tennstedt
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Burkhard
B
Beyer
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Jonas
J
Schiffmann
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Martini-Clinic, Prostate Cancer Diagnostic Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ann
A
Beckmann
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Uwe
U
Michl
Martini-Clinic, Prostate Cancer Diagnostic Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Diagnostic and Interventional Radiology Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Dirk
D
Beyersdorff
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Martini-Clinic, Prostate Cancer Diagnostic Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Lars
L
Budäus
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Markus
M
Graefen
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Pierre I
PI
Karakiewicz
Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Martini-Clinic, Prostate Cancer Diagnostic Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Georg
G
Salomon
D000368:Aged; D054459:Elasticity Imaging Techniques; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*
Diagnostic; Elastography; Gleason grade assignment; Imaging; Prostate cancer; Radical prostatectomy