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Introduction All malignancies, including prostate cancer, require accurate diagnosing and staging before a treatment decision can be made. The diagnostic process usually starts with PSA level determination and a physical [...]
Introduction: All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted biopsies should lower prostate cancer biopsy undergrading and overgrading. Goals: To determine the incidence of prostate cancer biopsy undergrading in patients who underwent a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy. Materials and methods: We identified the patients from our database who underwent a radical prostatectomy at our institution from January 1st, 2021, to June 30th, 2021. There were 112 patients identified. Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer. The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We compared the biopsy results with the final pathological results, and searched for undergrading or overgrading in the biopsies compared to the final histological report. Results: The undergrading was found in 17,7 % (N=ll) cases in the non-mpMRI group and in 12,0 % (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the final specimen report. The charasteristics of patients are listed in Table 1. Discussion and conclusion: In our cohort, the patients who underwent a mpMRI targeted biopsy had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate. Since different areas of the tumor have different areas of differentiation, only a low-grade part of the tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate than the analysis of prostate cores obtained by biopsy. Keywords: Prostate cancer, undegrading overgrading, prostate biopsy, prostate MRI Uvod: Sve maligne bolesti, ukljucujuci rak prostate, zahtijevaju preciznu dijagnostiku prije odluke o lijecenju. Uvodenjem ciljanih biopsija na temelju nalaza MRI prostate povecana je tocnost biopsije prostate. Vodene biopsije ciljaju na sam tumor u umjesto na najcesce lokacije tumora u prostati kao sto je slucaj sa sistemskom biopsijom. Neke studije pokazuju da bi ciljane biopsije trebale smanjiti podcjenjivanje stupnja diferenciranosti raka prostate u uzorcima dobivenim biopsijom prostate. Ciljevi: Odrediti incidenciju podcjenjivanje stupnja diferenciranosti raka prostate kod pacijenata koji su bili podvrgnuti klasicnoj sistemskoj biopsiji u usporedbi s pacijentima koji su bili podvrgnuti mpMRI kognitivnoj ciljanoj biopsiji. Materijali i metode: Identificirali smo pacijente iz nase baze podataka koji su podvrgnuti radikalnoj prostatektomiji u nasoj ustanovi od 1. sijecnja 2021. do 30. lipnja 2021. Identificirano je 112 pacijenata. Pacijenti su podijeljeni u dvije skupine na temelju vrste biopsije kojom je potvrden rak prostate. Skupina mpMRI (N=50) primila je mpMRI kognitivno vodenu transrektalnu ultrazvucnu (TRUS) biopsiju prostate, a skupina non-mpMRI (N=62) primila je klasicnu, sistemsku TRUS biopsiju. Usporedili smo rezultate biopsije s konacnim patoloskim nalazima i trazili smo podcjenjivanje stupnja diferenciranosti karcinoma prostate u biopsijama u usporedbi s konacnim histoloskim nalazom. Rezultati: Podcjenjivanje stupnja diferenciranosti nadeno je u 17,7 % (N=ll) u non-mpMRI skupini i u 12,0 % (N=6) slucajeva u mpMRI skupini (p=0,02, Mann-Whitney U test). U nasoj kohorti nije pronadeno precjenjivanje stupnja diferenciranosti. Svi slucajevi podcjenjivanja imali su Gradus grupu 1 na nalazu biopsije prostate i Gradus grupu 2 u konacnom patohistoloskom nalazu. Rasprava i zakljucak: U nasoj kohorti, pacijenti koji su bili podvrgnuti ciljanoj biopsiji imali su nizu incidenciju podcjenjivanja stupnja diferenciranosti sto je posljedica tocnijeg uzorkovanja.Tijekom sistemske TRUS biopsije, urolog cilja na podrucja prostate gdje se rak najcesce nalazi, sto je obicno periferna zona prostate. Buduci da razlicita podrucja tumora imaju razlicita podrucja diferencijacije, ponekad se bioptira samo dio tumora koji je bolje diferenciran, sto rezultira pogreskom uzorkovanja. Nakon sto je prostata uklonjena, analizira se cijeli tumor, tako da su rezultirajuci patohistololoski rezultati uklonjene prostate daleko tocniji od analize uzoraka prostate dobivenih biopsijom. Kljucne rijeci: Rak prostate, podstupnjevanje, nadstupnjevanje, biopsija prostate, magnetska rezonanca prostate