MRI-Targeted Prostate Biopsy Introduces Grade Inflation and Overtreatment

Abderrahim Oussama Batouche, Eugen Czeizler, Timo-Pekka Lehto, Andrew Erickson, Tolou Shadbahr, Teemu Daniel Laajala, Joona Pohjonen, Andrew Vickers, Tuomas Mirtti, Antti Sakari Rannikko
{"title":"MRI-Targeted Prostate Biopsy Introduces Grade Inflation and Overtreatment","authors":"Abderrahim Oussama Batouche, Eugen Czeizler, Timo-Pekka Lehto, Andrew Erickson, Tolou Shadbahr, Teemu Daniel Laajala, Joona Pohjonen, Andrew Vickers, Tuomas Mirtti, Antti Sakari Rannikko","doi":"10.1101/2024.01.10.24300922","DOIUrl":null,"url":null,"abstract":"Abstract\nPurpose: The use of MRI-targeted biopsies has led to lower detection of Gleason Grade Group 1 (GG1) prostate cancer and increased detection of GG2 disease. Although this finding is generally attributed to improved sensitivity and specificity of MRI for aggressive cancers, it might also be explained by grade inflation. Our objective was to determine the likelihood of definitive treatment and risk of post-treatment recurrence for patients with GG2 cancer diagnosed using targeted biopsies relative to men with GG1 cancer diagnosed using systematic biopsies. Materials and Methods: We performed a retrospective study on a large tertiary center registry (HUS Acamedic Datalake) to retrieve data on prostate cancer diagnosis, treatment, and cancer recurrence. We included patients with either GG1 with systematic biopsies (3317 men) or GG2 with targeted biopsies (554 men) from 1993 to 2019. We assessed the risk of curative treatment and recurrence after treatment. Kaplan-Meier survival curves were computed to assess treatment- and recurrence-free survival. Cox proportional hazards regression analysis was performed to assess the risk of posttreatment recurrence. Results: Patients with systematic biopsy detected GG1 cancer had a significantly longer median time-to-treatment (31 months) than those with targeted biopsy detected GG2 cancer (4 months, p<0.0001). Risk of recurrence after curative treatment was similar between groups with the upper bound of the 95% CI, excluding an important difference (HR: 0.94, 95% CI [0.71-1.25], p=0.7). Conclusions: GG2 cancers detected by MRI-targeted biopsy are treated more aggressively than GG1 cancers detected by systematic biopsy, despite having similar oncologic risk. To prevent further overtreatment related to the MRI pathway, treatment guidelines from the pre-MRI era need to be updated to consider changes in the diagnostic pathway.","PeriodicalId":501140,"journal":{"name":"medRxiv - Urology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"medRxiv - Urology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1101/2024.01.10.24300922","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Abstract Purpose: The use of MRI-targeted biopsies has led to lower detection of Gleason Grade Group 1 (GG1) prostate cancer and increased detection of GG2 disease. Although this finding is generally attributed to improved sensitivity and specificity of MRI for aggressive cancers, it might also be explained by grade inflation. Our objective was to determine the likelihood of definitive treatment and risk of post-treatment recurrence for patients with GG2 cancer diagnosed using targeted biopsies relative to men with GG1 cancer diagnosed using systematic biopsies. Materials and Methods: We performed a retrospective study on a large tertiary center registry (HUS Acamedic Datalake) to retrieve data on prostate cancer diagnosis, treatment, and cancer recurrence. We included patients with either GG1 with systematic biopsies (3317 men) or GG2 with targeted biopsies (554 men) from 1993 to 2019. We assessed the risk of curative treatment and recurrence after treatment. Kaplan-Meier survival curves were computed to assess treatment- and recurrence-free survival. Cox proportional hazards regression analysis was performed to assess the risk of posttreatment recurrence. Results: Patients with systematic biopsy detected GG1 cancer had a significantly longer median time-to-treatment (31 months) than those with targeted biopsy detected GG2 cancer (4 months, p<0.0001). Risk of recurrence after curative treatment was similar between groups with the upper bound of the 95% CI, excluding an important difference (HR: 0.94, 95% CI [0.71-1.25], p=0.7). Conclusions: GG2 cancers detected by MRI-targeted biopsy are treated more aggressively than GG1 cancers detected by systematic biopsy, despite having similar oncologic risk. To prevent further overtreatment related to the MRI pathway, treatment guidelines from the pre-MRI era need to be updated to consider changes in the diagnostic pathway.
磁共振成像靶向前列腺活检会导致分级膨胀和过度治疗
摘要:目的:磁共振成像靶向活检的使用降低了格里森1级(GG1)前列腺癌的检出率,增加了GG2疾病的检出率。虽然这一发现通常归因于磁共振成像对侵袭性癌症的灵敏度和特异性的提高,但也可能是由于分级膨胀造成的。我们的目的是确定通过靶向活检确诊的 GG2 癌症患者与通过系统活检确诊的 GG1 癌症患者接受明确治疗的可能性和治疗后复发的风险。材料与方法:我们对大型三级中心登记处(HUS Acamedic Datalake)进行了一项回顾性研究,以检索有关前列腺癌诊断、治疗和癌症复发的数据。我们纳入了1993年至2019年期间接受系统活检的GG1患者(3317名男性)或接受靶向活检的GG2患者(554名男性)。我们评估了治愈性治疗和治疗后复发的风险。我们计算了卡普兰-米尔生存曲线,以评估无治疗和无复发生存率。进行了 Cox 比例危险回归分析,以评估治疗后复发的风险。结果系统活检发现 GG1 癌症的患者的中位治疗时间(31 个月)明显长于靶向活检发现 GG2 癌症的患者(4 个月,p<0.0001)。治愈性治疗后的复发风险在各组之间相似,95% CI 的上限排除了重要差异(HR:0.94,95% CI [0.71-1.25],P=0.7)。结论与系统活检发现的GG1癌症相比,通过磁共振成像靶向活检发现的GG2癌症尽管具有相似的肿瘤风险,但治疗的积极性更高。为防止与核磁共振成像路径相关的过度治疗进一步发生,需要更新核磁共振成像前时代的治疗指南,以考虑诊断路径的变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信