Non-index Lesions at Biopsy Help Predict Adverse RP Outcomes

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Systematic biopsy parameters identified patients at higher risk of positive surgical margins.
Systematic biopsy parameters identified patients at higher risk of positive surgical margins.
The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017. 

BOSTON — Targeted plus systematic biopsy provides crucial information that can lead to better radical prostatectomy (RP) outcomes, according to new study findings presented at the American Urological Association 2017 annual meeting.

“A systematic sample of the prostate provides useful preoperative information on the risk of adverse pathologic outcomes and should always be considered in association with targeted biopsies,” a team including Giorgio Gandaglia, MD, and Marco Bandini, MD, of Università Vita-Salute San Raffaele in Milan, Italy, stated.

Investigators reviewed biopsy specimens from 758 prostate cancer (PCa) patients who underwent RP 2012 to 2016, identifying index and non-index lesions for each patient. The index lesion was defined as the highest-grade core or multiple cores from a single area with higher-grade disease. Non-index lesions included lower-grade cores in other areas or fewer positive cores in another locale.

The team examined the impact of non-index lesions on RP outcomes, including extracapsular extension (ECE), seminal vesicle involvement (SVI), and positive surgical margins (PSM). Of surgery patients, 37.5% had ECE, 10.9% had SVI, and 19.1% had PSM, according to final pathology.

The presence of non-index lesions was associated with greater risks of ECE, SVI, and PSM by 2.12, 2.74, and 2.16 times, respectively, according to multivariable analyses. Likewise the number of positive cores in the non-index lesion was associated with 1.09, 1.13, and 1.07 times greater risks of ECE, SVI, and PSM, respectively. Results were adjusted for biopsy Gleason score, the number of positive cores in the index lesion, clinical stage, and PSA.

When investigators incorporated the presence of non-index lesions and the number of positive cores in the non-index lesion into a model, they found that it significantly improved prediction of PSM (area under curve 69.4% vs 67.0%). “The inclusion of these parameters improves our ability to identify patients at higher risk of PSM,” Dr Gandaglia and colleagues concluded.

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Reference

Gandaglia G, Bandini M, Dell'Oglio P, et al. Does the inclusion of non-index lesions at biopsy improve our ability to predict adverse pathologic outcomes at radical prostatectomy? Implications for targeted plus systematic biopsy schemes. [abstract] J Urol 2017;197(4S);e19-e20. Poster presented at the American Urological Association 2017 annual meeting in Boston on May 12, 2017. Poster MP03-04.

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