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Overdiagnosis and stage migration of ISUP 2 disease due to mpMRI-targeted biopsy: facts or fictions

Prostate Cancer and Prostatic Diseases volume 25, pages 794–796 (2022)Cite this article

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A Correction to this article was published on 20 January 2023

This article has been updated

Abstract

Recently, the use of targeted biopsy has been subject to critics, as it has been speculated that targeted biopsy might lead to overdiagnosis of clinically significant prostate cancer (PCa). In this study, we tried to evaluate whether targeted sampling in patients with organ-confined disease and ISUP 2 disease was associated with downgrading of the prostatectomy specimen, hence, leading to an unnecessary treatment, in terms of radical surgery. We relied on a prospectively-maintained multi-institutional database and identified 1293 patients with ISUP 2 disease on targeted biopsy only. Median (IQR) patients’ age at diagnosis was 65 (60, 70) years. Median PSA was 6.8 (5.0, 9.6) ng/ml. Overall, only 33 (2.6%) patients presented downgrading on their RP specimens. Patients who experienced downgrading were biopsied more frequently trans-rectally, had a lower total tumor length in mm and lower percentage of maximum core involvement and lower rates of cancer on systematic biopsy (all p ≤ 0.03). The strongest factors associated with reduced risk of downgrading were total tumor length, in mm, (OR: 0.71, 95% CI: 0.62,0.82, p < 0.001) and transperineal biopsy route (OR: 0.38, 95% CI: 0.14,1.00, p = 0.05).

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Data are available for bona fide researchers upon request.

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Authors and Affiliations

  1. La Croix du Sud Hospital, Quint Fonsegrives, France

    Alberto Martini, Alae Touzani & Guillame Ploussard

  2. Institut Universitaire du Cancer-Toulouse, Oncopole, Toulouse, France

    Alberto Martini & Guillame Ploussard

  3. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Elio Mazzone, Francesco Montorsi, Alberto Briganti & Giorgio Gandaglia

  4. Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France

    Mathieu Roumiguié

  5. Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy

    Giancarlo Marra & Paolo Gontero

  6. Urology Department, Lausanne University Hospital, Lausanne, Switzerland

    Massimo Valerio

  7. Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, PR China

    Jean Baptiste Beauval, Junlong Zhuang & Hongqian Guo

  8. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Riccardo Campi & Andrea Minervini

  9. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Riccardo Campi & Andrea Minervini

  10. Department of Urology, St. Antonius Hospital, Santeon-group, Utrecht, The Netherlands

    Roderick C. N. van den Berg, Timo F. W. Soeterik & Roderick C. N. van den Berg

Authors
  1. Alberto Martini
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  2. Alae Touzani
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Consortia

Young Academic Urologists Working Group on Prostate Cancer of the European Association of Urology

  • Alberto Martini
  • , Giancarlo Marra
  • , Massimo Valerio
  • , Roderick C. N. van den Berg
  • , Timo F. W. Soeterik
  • , Giorgio Gandaglia
  •  & Guillame Ploussard

Contributions

Study concept and design: GP, AM. Acquisition of data: All authors. Analysis and interpretation of data: AM, GP. Drafting of the manuscript: AM, GP. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: AM. Supervision: GP.

Corresponding author

Correspondence to Guillame Ploussard.

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Competing interests

AM and GP own equities of Oltre Medical Consulting, Toulouse, France. The other authors have no conflicts.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: In Table 1 of this article, a line was missing in the legend. It should have read ‘pT Stage is coded as follows: 0 = pT2, 1 = pT3a, 2 = pT3b and 3 = pT4’. In the sentence ‘We identified 1293 patients with complete data and no prior prostate biopsy.’ in this article should have read ‘We identified 1293 patients with complete data.’

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Martini, A., Touzani, A., Mazzone, E. et al. Overdiagnosis and stage migration of ISUP 2 disease due to mpMRI-targeted biopsy: facts or fictions. Prostate Cancer Prostatic Dis 25, 794–796 (2022). https://doi.org/10.1038/s41391-022-00606-6

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