Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Introduction: To explore stage migration patterns of primary diagnostic tools of prostate cancer, namely systematic biopsy (SBx) and the dawn of MRI-targeted biopsy (TBx) combined with SBx.
Methods: Within our institutional database, we identified 7,470 SBx and 1,717 TBx+SBx patients, who received respective primary diagnostics between 2005-2020 and 2016-2020. The estimated annual percentage changes (EAPC) for Gleason Grade Groups (GGG) and for proportion strata of PCa yield, within overall biopsy tissue was calculated by a log linear regression methodology. For TBx+SBx, adjustment according to PIRADS strata 3,4 and 5 was performed.
Results: At SBx, the incidence of GGG 1 (EAPC -3.45) and GGG 3 (EAPC -3.51) significantly decreased, accompanied by an increase of GGG 5 (EAPC +10; p=0.003). Similarly, proportion of biopsy tissue PCa yield >20% also significantly increased (EAPC: +3.71; p=0.002). After TBx+SBx was introduced at our institution 2016, the percentage of TBx+SBx for purpose of primary PCa diagnostics (as opposed to repeat Bx) increased from 12% to 52% until 2020. There were no significant EAPCs of TBx+SBx GGGs within this period. During the period 2016-2020, clinically significant GGG =2 was detected at a significantly higher rate of 58% at TBx+SBx compared to 46% at SBx, respectively.
Conclusions: Increased high-risk GGG 5 proportions at SBx strongly suggest that previously observed inverse stage migration pattern of unfavorable PCa characteristics at first diagnosis are still present in contemporary PCa patients. However, the greater comparable yield of clinically significant PCa at TBx+SBX also indicates that the inverse stage migration of SBx might systematically underestimate truly aggressive PCa burden due to poorer diagnostic performance. This must be taken into account when considering a primary biopsy examination, supporting the existing recommendations regarding primary MRI and TBx based diagnostics.
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