4690. Correlating Radical Prostatectomy Pathology with MRI-Guided Targeted Biopsy: Comparison Between PI-RADS v2.0 and v2.1
Authors* Denotes Presenting Author
Enis Yilmaz *;
National Cancer Institute/National Institutes of Health - Molecular Imaging Branch
Yue Lin;
National Cancer Institute/National Institutes of Health - Molecular Imaging Branch
Mason Belue;
National Cancer Institute/National Institutes of Health - Molecular Imaging Branch
Stephanie Harmon;
National Cancer Institute/National Institutes of Health - Molecular Imaging Branch
Peter Choyke;
National Cancer Institute/National Institutes of Health - Molecular Imaging Branch
Peter Pinto;
National Cancer Institute/National Institutes of Health - Urologic Oncology Branch
Ismail Turkbey;
National Cancer Institute/National Institutes of Health - Molecular Imaging Branch
Objective:
This study aims to compare the International Society of Urological Pathology grade group (GG) upgrading and downgrading rates of prostate cancer (PCa) from targeted biopsy to radical prostatectomy (RP) between the PI-RADS v2.0 and v2.1 eras.
Materials and Methods:
This retrospective study included patients who had 3-T mpMRI, underwent MRI/ultrasound (US) fusion-guided biopsy and subsequent RP between May 2015 and March 2023. All mpMRI reads were prospectively conducted by one genitourinary radiologist using PI-RADS v2.0 (May 2015 to March 2019) and PI-RADS v2.1 (April 2019 to March 2023). Two TBx cores were obtained from each lesion. For each patient, the highest GG per TBx was then compared with GG per RP histopathology. The association of RP GG with clinical parameters (age and PSA density [PSAD]), MRI findings (index lesion PI-RADS score, index lesion maximum diameter, number of lesions at MRI), and TBx GGs were evaluated using Kendall’s tau. Overall GG upgrading and downgrading rates from TBx to RP were compared between the two cohorts using the chi-squared test. The differences in rates of clinically significant upgrading (from < GG2 to > GG3) and downgrading (from > GG3 to < GG2) were also assessed with the chi-squared test. To account for multiple testing, <em>p</em> values < 0.01 were considered statistically significant.
Results:
A total of 308 patients were included in the study. In the v2.0 group (<em>n</em> = 177), the median age and PSAD were 65 years (interquartile range [IQR], 59 - 68) and 0.16 ng/mL2 (IQR, 0.10 - 0.23), respectively. In the v2.1 cohort (<em>n</em> = 131), median age and PSAD were 65 (IQR, 61 - 71) years and 0.15 (IQR, 0.10 - 0.25) ng/mL2, respectively. The overall upgrading rate of the v2.0 cohort (29% [52 / 177]) was comparable to that of the v2.1 group (22% [29 / 131]) (<em>p</em> = 0.15). Moreover, the overall downgrading rate of the two cohorts was also similar (v2.0: 19% [34 / 177] vs v2.1: 21% [27 / 131], <em>p</em> = 0.76). The clinically significant upgrading (v2.0: 11% [20 / 177] vs v2.1: 9% [12 / 131], <em>p</em> = 0.54) and downgrading rates (v2.0: 11% [19 / 177] vs v2.1: 13% [17 / 131], <em>p</em> = 0.54) did not differ between the two groups. In the v2.0 cohort, PSAD (<em>t</em> = 0.24, <em>p</em> < 0.001) and the highest TBx GG (t = 0.53, <em>p</em> < 0.001) were positively correlated with RP GGs. In parallel, positive correlations with RP GGs were observed within the v2.1 group for PSAD (<em>t</em> = 0.24, <em>p</em> < 0.001) and the highest TBx GG (<em>t</em> = 0.58, <em>p</em> <0.001). In both groups, index lesion PI-RADS score, index lesion maximum diameter, and number of lesions on MRI were not found to be associated with RP GGs.
Conclusion:
Transitioning from v2.0 to v2.1 did not impact the upgrading and downgrading rates of PCa from TBx to RP. Although PI-RADS scores of prebiopsy MRIs did not strongly correlate with RP GGs, a moderate correlation was found between TBx and RP GGs in both cohorts.
