Targeted Biopsy Detects Gleason Score Upgrading in AS
Men with Gleason score 3 + 4 were 4.65 times more likely to have upgrading than men with an initial Gleason score of 3 + 3 at 3 years.
(HealthDay News) — Targeting of tracked tumor foci allows for improved detection of Gleason score 4 + 3 or greater cancers among men under active surveillance for prostate cancer, according to a study published in the March issue of The Journal of Urology.
Nima Nassiri, MD, from the University of California in Los Angeles, and colleagues examined the rate of upgrading to Gleason score 4 + 3 or greater in 259 prostate cancer patients who were diagnosed via magnetic resonance imaging (MRI)/ultrasound fusion guided biopsy from 2009 to 2015 and underwent fusion biopsy during active surveillance.
The researchers found that men with Gleason score 3 + 4 were 4.65 times more likely to have upgrading at 3 years than men with Gleason score of 3 + 3 (P <.01). By the third surveillance year, 63 and 18.0% of men with Gleason score 3 + 4 and 3 + 3, respectively, had been upgraded (P <.01). Ninety-seven percent of the 33 upgrades occurred at a MRI-visible or a tracked site of tumor, instead of a previously negative systematic site. Gleason score 3 + 4, prostate-specific antigen density 0.15 ng/ml/cm³ or greater, and a grade 5 lesion on MRI were independent predictors of upgrading.
"During active surveillance of prostate cancer, targeting of tracked tumor foci by MRI/ultrasound fusion biopsy allows for heightened detection of Gleason score 4 + 3 or greater cancers," the authors write.
- Nassiri N, Margolis DJ, Natarajan S, et al. Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate Cancer. J Urol. March 2017. doi: 10.1016/j.juro.2016.09.070