Spatial Correlation of Clinically Significant Prostate Cancer Between Multiparametric Magnetic Resonance Imaging, Targeted and Systematic Biopsy, and Whole-mount Pathology: Implications for Optimal Prostate Biopsy Strategy

Abstract PURPOSE To pinpoint clinically significant Prostate Cancer (csPCa) sites at whole mount pathological analysis (WMA) after radical prostatectomy and compare the results obtained to multiparametric magnetic resonance imaging (mpMRI) and fusion targeted prostate biopsy (TB) combined or less with systematic biopsy (TSB) findings.METHODS 688 patients who underwent to mpMRI and prostate biopsy (PB) were retrospectively evaluated in a multicenter cohort study. 435 of them showed PIRADS ≥ 3 lesions at mpMRI and underwent to Targeted plus Systematic (TSB) or Targeted biopsies alone (TB). Only 201 patients underwent to radical prostatectomy and were suitable for final analysis. T-test for paired DATA and Pearson’s correlation analysis were performed to assess the agreement between different methods.RESULTS The correlation between mpMRI, prostate biopsy and WMA reports was good and comparable in both groups. PI-RADS 4 and 5 lesions agreed with TB and WMA findings. However, about 50% of csPCa tumor sites remained undetected at mpMRI. No correlation in TB group for PI-RADS 3 lesions was found. TSB was able to identify 20% more csPCa sites than TB although the higher risk of tumor upgrading.CONCLUSIONS mpMRI is still an accurate method for the diagnosis of PCa, mainly for PI-RADS 4 and 5 lesions although some csPCa sites often remain undetected. This may be considered as a critical issue for the surgical planning in order to avoid the risk of positive margins. The use of TSB improves the location agreement between PB and WMA up to 80% but may increase the risk of tumor upgrading.