Optimized grade group for reporting prostate cancer grade in systematic and MRI‐targeted biopsies

Abstract

Purpose: To explore an optimized grade group (oGG) criterion from systematic biopsies (SB) and targeted biopsies (TB) and offer a better prediction of radical prostatectomy (RP) grade group (GG).Methods: Positive needles were collected from 146 patients who underwent SB + TB followed by RP. The grade was assigned for two different kinds of biopsies with five GG criteria: (1) global GG (gGG); (2) most common GG (most common GG from SB + TB, mGG); (3) highest GG (highest numerical GG from SB + TB, hGG); (4) largest volume/linear length cancer GG (defined as GG from the SB + TB with the largest length of cancer in a needle, lGG). These biopsy grades were compared (equivalence, upgrade, or downgrade) with the final grade of the RP lesion, using weighted κ coefficients; (5) Then the best agreement of the (2) (3) (4) grading scores from SB or TB was combined to introduce an oGG.Results: In this study, gGG showed generally poor agreement (47.2%) with RP GG (weighted κ: 0.43). Using the three criteria (mGG, hGG, and lGG) of SB, mGG had the best agreement (55.5%, weighted κ: 0.46), while hGG and lGG had a lower agreement (48.6% and 48.6%, weighted κ: 0.42 and 0.38). Using the three criteria (mGG, hGG and lGG) of TB: lGG had the best agreement (56.8%, weighted κ: 0.43), while mGG and hGG had lower agreement (50.0% and 49.3%, weighted κ: 0.40 and 0.40); Then oGG was generated (higher GG between mGG of SB and lGG of TB) and the agreement of oGG increased to 59.6% and weighted κ was 0.49. Additionally, oGG had a lower upgrade rate than gGG, while the downgrade rate remained unchanged.Conclusions: oGG showed better agreement with RP GG than gGG. oGG had a lower upgrade rate than gGG, while downgrade rate remained unchanged.

Prostate magnetic resonance imaging‐targeted biopsy global grade correlates better than highest grade with prostatectomy grade

“…In addition, a recent study has demonstrated that the gGG combining all positive targeted and standard biopsy cores resulted in a suboptimal concordance rate (47.2%) with the RPGG. 22 While standard and targeted biopsies may often be performed in conjunction, our results support the current guidelines to report the grade of the targeted and standard cores separately. By focusing on a highly selective cohort of MRI-targeted prostate biopsies where gGG ≠ hGG, we illustrated the advantages and limitations of each biopsy grading method and circumstances where one method may be preferentially used over the other.…”

“…The high proportion of targeted lesions with gGG = hGG likely masked the power of either biopsy method to predict the RPGG independently. In addition, a recent study has demonstrated that the gGG combining all positive targeted and standard biopsy cores resulted in a suboptimal concordance rate (47.2%) with the RPGG 22 . While standard and targeted biopsies may often be performed in conjunction, our results support the current guidelines to report the grade of the targeted and standard cores separately.…”

Synthetic Histology Images for Training AI Models: A Novel Approach to Improve Prostate Cancer Diagnosis

“…This diagnostic pathway is commonly used to assess PCa prognosis. Multiple follow-up appointments are recommended, especially for men under active surveillance [47][48][49][50] .Notably, over 77% of men with localized PCa are suitable for active surveillance, and this number has increased from 15.5% to 42.2% over the last decade. These men require repeat follow-ups every six months or 1 year if enrolled 51-53 .…”

“…Positive results on these assays may prompt imaging studies, such as MRI, to identify potential areas of PCa [40][41][42][43][44][45] . Clinicians may also perform biopsies for further evaluation by pathologists and genomic testing [46][47][48][49][50] . This diagnostic pathway is commonly used to assess PCa prognosis.…”

“…If the PSA levels are above the normal range, the patient is evaluated using one of several assays such as 4Kscore 20-26 , PCA3 [27][28][29][30][31][32][33] , or phi [34][35][36][37][38][39] .Positive results on these assays may prompt imaging studies, such as MRI, to identify potential areas of PCa [40][41][42][43][44][45] . Clinicians may also perform biopsies for further evaluation by pathologists and genomic testing [46][47][48][49][50] . This diagnostic pathway is commonly used to assess PCa prognosis.…”