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prostatectomy (26–36%)
[5,18]. Novel techniques such as
multiparametric magnetic resonance imaging (MRI) and
MRI/transrectal ultrasound fusion-guided prostate biopsy
are frequently utilized to better characterize the prostate,
identify potential higher-grade cancers, and determine
whether treatment or active surveillance is most appropri-
ate. For example, in a prospective study by Siddiqui et al
comparing MRI fusion-guided biopsy to standard 12-core
biopsy in
>
1000 men, the former diagnosed 30% more
higher-risk cancers ( GS[4 + 3]) and 17% fewer GS6 and
low-volume GS7 (
<
20%) cancers
[19]. Meng et al had
similar findings of more GS7 and fewer GS6 cancers
identified with MRI fusion biopsy compared to standard
12-core biopsy
[20]. Further prospective studies of techni-
ques to more accurately image and diagnose prostate
cancer on biopsy will provide valuable information for
patients and clinicians in finalizing a management decision.
Table 2 – Gleason score 6 T3
Original Gleason 6
Post repeat pathologic review
N
= 60
T3a (%)
55 (92%)
Grading
Staging
3 + 3
10 (18%
) aT2a
4 (7%)
3 + 4
44 (80%)
T2c
4 (7%)
4 + 4
1 (2%)
T3a
47 (86%)
T3b (%)
5 (8%)
Grading
Staging
3 + 3
0 (0%)
T2
0 (0%)
3 + 4
3 (60%)
T3a
0 (0%)
4 + 3
2 (40%)
T3b
5 (100%)
Total upgrading (%)
50/60 (83%)
a
7/10 (70%) T3a Gleason 6; 3/10 (30%) T2a Gleason 6; in total 7/60 (11.7%) remained T3.
Table 1 – Baseline characteristics of study cohorts
Parameter
Gleason 7
Gleason 6
Gleason 6 T
3 ap
value
Number of patients (
N
) b5315
2442
60
–
Age (mean SD, yr)
60.0 7.1
58.6 7.0
60.9 6.9
<
0.01
Race (%)
<
0.01
Caucasian
3645 (77)
1834 (81)
44 (80)
African American
626 (13)
239 (11)
8 (15)
Other
456 (10)
198 (9)
3 (5)
Preoperative PSA (ng/ml)
(mean SD)
7.7 9
5.2 3.7
5.1 2.0
<
0.01
BMI 30 (kg/m
2
) (%)
1567 (30)
592 (25)
14 (23)
<
0.01
Pathologic stage (%)
<
0.01
T2a
243 (5)
442 (18)
0
T2b
151 (3)
452 (19)
0
T2c
2466 (55)
1516 (63)
0
T3a
1255 (28)
0
55 (92)
T3b
356 (8)
0
5 (8)
T3c
9 (
<
1)
0
0
T4
1 (
<
1)
0
0
Node status (%)
<
0.01
Nx
890 (17)
1463 (60)
35 (58)
N0
4065 (76)
978 (40)
25 (42)
N1
386 (7)
0
0
Perineural invasion (%)
4471 (85)
1135 (46)
45 (75)
<
0.01
Positive margin rate (%)
964 (18)
231 (9)
19 (32)
<
0.01
BMI = body mass index; PSA = prostate-specific antigen; SD = standard deviation.
a
These 60 patients had Gleason score 6 pT3 before repeat pathologic review.
b
The total
N
per column will not always reflect totals in subcategories because of missing datapoints.
Table 3 – Gleason score 7–9 T3b cases
Parameter
Gleason 7–9 T3b
N
= 132
Review Gleason score (%)
3 + 3
0 (0%)
3 + 4
41 (31%)
4 + 3
25 (19%)
8
13 (10%)
9
53 (40%)
Review stage (%)
pT2c
1 (1%)
pT3b
131 (99%)
Node status (%)
Nx
8 (6%)
N0
76 (58%)
N1
48 (36%)
Perineural invasion (%)
127 (98%)
Positive margin rate (%)
50 (38%)
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 4 5 5 – 4 6 0
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