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

doi:10.21203/rs.3.rs-4086363/v1

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.

Health sciences/Diseases/Cancer/Urological cancer/Prostate cancer

Biological sciences/Cancer/Urological cancer/Prostate cancer

prostate cancer diagnosis

multiparametric magnetic resonance

targeted fusion prostate biopsy

systematic prostate biopsy

whole mount pathological analysis

Diagnostic tools for prostate cancer (PCa) include total Prostate Specific Antigen serum level (tPSA), Digital-Rectal Examination (DRE), multiparametric Magnetic Resonance imaging (mpMRI) and Prostate Biopsy (PB) [1].

Early detection of PCa may be promoted by increased levels of tPSA with unfavorable free to total ratio, although the objective risk for overdiagnosis of non-clinically significant PCa (nsPCa) and/or misdiagnosis of clinically significant PCa (csPCa) may lead to subsequent overtreatment and repeated assessments of patients according to active surveillance protocols [2–6]. The definition of csPCa includes the pathological evidence of intermediate/high risk PCa (ISUP score ≥ 2) [1, 7]. Multiparametric magnetic resonance of the prostate has improved the diagnostic accuracy for PCa detection thanks to diffusion-weighted and dynamic contrast-enhanced imaging sequences [8]. Previous studies already investigated on the presence of csPCa by the correlation between mpMRI lesions and radical prostatectomy specimens [9–12]. mpMRI diagnostic accuracy for the diagnosis of PCa was found as variable from 50–89% according to different clinical series of patients [12–14]. In particular mpMRI showed conflicting results for patients with Prostate Imaging and Reporting Data System (PI-RADS) 3 classification. Current literature shows that PI-RADS 3 lesions are confirmed as cancers in 14,8% to about 30% of cases (the detection of csPCa may be lower) and that the interpretation of those lesions may vary depending on the referring radiologist skill and experience on the topic [15–17]. In addition, tumor sites not recognized and reported by mpMRI may be often easily identified by systematic core samples and related to the number of cores performed on the same patient [1, 18]. The European Association of Urology (EAU) 2023 guideline recommend performing targeted and systematic biopsies in naïve patients when mpMRI in positive (strength rating: strong). [1]. Few existing studies regarding the correlation between tumor site and tumor burden in clinically localized PCa also showed conflicting results.

The aim of this study was to describe the location, local burden and characteristics of clinically significant prostate cancer sites as described in whole mount pathological analysis (WMA) after radical prostatectomy and to compare the obtained results with PI-RADS v2.1 ≥ 3 lesions found at preoperative mpMRI and at fusion or fusion plus additional systematic prostate biopsy.

Participants. A dataset of clinical and pathological data related to 688 patients who had a clinical suspicion of PCa was retrospectively collected in a multicenter cohort study. Patients’ reports were collected consecutively from January 2019 and December 2022 according to the STROBE Statement for cohort studies. All patients underwent a mpMRI before prostate biopsy. 253 (36,77%) patients were excluded because mpMRI were negative (no matching of PI-RADS ≥ 3 lesion), but the increasing of tPSA serum levels and/or the presence of a clinical suspicion at DRE and/or familiar history of PCa encouraged a prostate biopsy for 168 of them (24,41%) with subsequent diagnosis of cancer in 59 patients (35,12%). 435 had a mpMRI report with one or more PI-RADS ≥ 3 lesions and underwent prostate biopsy. 96 of 435 (22,06%) biopsies resulted as negative. Among 339 patients with positive biopsies, 34 (10,02%) had the finding of nsPCa and were excluded from the study, whilst 104 out 305 of the remaining patients with csPCa received external beam radiotherapy due to personal preference, age, or concomitant comorbidities. 201 patients underwent radical prostatectomy and were enrolled for the study. Clinical and pathological data were collected and analyzed from clinical dataset. (Fig.1)

Inclusion Criteria.

Preoperative PSA serum level between 4 and 20 ng/ml and/or suspicion of PCa at DRE and/or familiarity for PCa.
Preoperative mpMRI with at least one PI-RADS ≥ 3 lesion.
Bioptic matching of IPSU ≥ 2 PCa (defined as csPCa).
Patients who had undergone radical surgical treatment for localized csPCa.

Exclusion Criteria.

Patients with preoperative PSA serum levels > 20 ng/ml.
Patients without suspicion of PCa at mpMRI.
Patients with extra-prostatic disease at pre-operative staging procedures.
Contraindications to mpMRI, prostate biopsy or radical surgery.

Compliance with Ethical Standards. This multicenter retrospective analytical cohort study was approved on 12.12.2022 by the Institutional Review Board and Ethics Commettee of the Department of Medical and Surgical sciences and Biotechnologies of Sapienza University in Rome (UROLT_DEC22/7834). The principles of the Declaration of Helsinki were followed and written informed consent was obtained from all participants.

mpMRI and biopsy. Patients underwent a 3.0 Tesla multiparametric magnetic resonance imaging before prostate biopsy. All mpMRIs were revised from two intra/extra observer expert radiologists for the study review although the first report was used by urologists as a guide for targeted prostate biopsy. According to consensus guidelines T2 weighted, diffusion weighted, and dynamic contrast-enhanced sequences were acquired. Positive areas at mpMRI were stratified by expert urogenital radiologists according to PI-RADS v2 or 2.1 classification (v2 were applied for mpMRI performed before v2.1 publication) with higher scores suggesting an increased probability of clinically significant cancers. [19,20,21]. All recruited patients who had undergone to mpMRI with subsequent reporting of at least one PI-RADS ≥ 3 lesion were thus submitted to prostate biopsy. Expert urologists performed prostate biopsies. Targeted plus Systematic Biopsy (TSB) was performed with at least 3-4 targeted and 16 systematic cores in 105 patients (52,24%) while Targeted Biopsy (TB) with only 3-4 targeted cores was performed in 96 patients (47,76%). In the case of more than one Region of Interest (ROI) at mpMRI, a maximum of 3 of those lesions were sampled according to current literature [18]. Both trans perineal and trans rectal approaches were used. For trans perineal biopsies no antibiotic prophylaxis was given. In contrast, for transrectal biopsies, antibiotic prophylaxis with Fosfomycin 3g plus Ceftriaxone 1g and a rectal cleansing with povidone-iodine were administered.

UroFusion and bkFusion software were used to run targeted samples.

Staging Evaluations. According to EAU latest guidelines, patients with intermediate and high-risk cancers underwent contrast-enhanced abdominopelvic CT scan and whole-body bone scan. Whole body Prostate Specific Membrane Antigen (PSMA) PET/CT was also performed in high-risk to minimize the risk of metastatic disease [1].

Radical Prostatectomy. Once the histological diagnosis of csPCa was acquired, all patients underwent robot-assisted radical prostatectomy (RARP) with Montsouris approach. All surgical procedures were performed by expert surgeons with Da Vinci Xi surgical system by Intuitive. All WMA pathologic reports included intra-prostatic disease locations to allow the comparison with mpMRI and PB.

Outcomes. Assumed that mpMRI improves the diagnostic pathway of PCa and helps avoiding unnecessary biopsies, the primary outcome was to evaluate the mpMRI accuracy in detecting all prostatic disease foci, when compared to prostate biopsy (TB or TSB) and WMA. In this view, we evaluated the spatial correlation between ROIs at mpMRI, positive cores at PB (both TB and TSB) and WMA for each patient. Radiologists and pathologists’ collaboration was requested to avoid errors comparing lesions’ location. Our secondary outcome was the evaluation and quantification of prostate biopsy failure in location and detection of csPCa lesions. Another outcome was to evaluate the correlation between mpMRI, PB and WMA in terms of PI-RADS score and Gleason Score at PB and WMA.

Statistical Analysis and Study Drafting.

Our manuscript was drafted according to STROBE Statement items for cohort studies.

Categorical data were described with absolute and relative (%) frequency, continuous data were summarized with mean and standard deviation (sd).

To compare group (TB, TBS) with continuous and categorical population characteristics t-test for independent sample and chi square test was applied, respectively.

To assess the agreement between methods (mpMRI ROIs, Biopsy positive areas, WMA) t-test for paired data and Pearson’s correlation analysis were performed.

Significance was set at 5% and all analyses were carried out by SPSS v.29 technology.

Population. Among all 201 recruited patients, 95 (47.26%) underwent TB and 106 (52.74%) underwent TSB. No significant differences between the two groups were found in terms of age at the time of surgery, Body Mass Index (BMI), pre-surgery tPSA, age adjusted Charlson Comorbidity Index (aaCCI), DRE and smoking habit (Table I. Pre-Surgery Demographic and Clinical Characteristics of the Patients).

Spatial correlation with whole-mount analysis of mpMRI and Prostate Biopsy. In both groups the spatial correlation between mpMRI ROIs, PB positive areas and whole-mount analysis is good. In particular, we found a Pearson’s correlation coefficient (r) of 0.425 (p<0.001) comparing mpMRI ROIs with PB positive areas for TSB group. Concerning the spatial correlation between mpMRI and WMA and between PB and WMA in the same group r=0,441 (p<0.001) and of r=0.704 (p<0.001), respectively. In TB group r=0.718 (p<0.001) correlating mpMRI with PB, r=0.546 (p<0.001) for the correlation between mpMRI and WMA and r=0.615 (p<0.001) correlating PB and WMA (Table II).

Pearson’s correlation was good also stratifying different PI-RADS categories in both groups. It must be highlighted that the best correlation was found for PI-RADS 5 lesions in TB group (r=0.815, p<0.0001) correlating mpMRI ROIs with PB. The correlation is slightly worse comparing mpMRI with WMA (r=0.660, p<0.0001). Targeted and Systematic biopsy (TSB) has the best performance in PI-RADS 3 ROIs: r=0.802 (p<0.0001) between mpMRI and PB and r=0.719 (p<0.0001) between mpMRI and WMA. Concerning PI-RADS 3 lesions, mpMRI does not correlate with WMA in TB group (r=0.267, p=0.218) (Table II).

Concordance of spatial correlation between mpMRI report, PB and WMA was found, whilst the difference between PB approaches compared to WMA is not statistically significant (p=0,141 at Parallelism test). The addition of systematic samplings to targeted cores leads to a slight improvement in terms of correlation between PB and WMA.

For PI-RADS 3 ROIs, mpMRI doesn’t seem as reliable as it is for PI-RADS 4 and 5 lesions. The obtained results in terms of spatial correlation can be explained considering that PI-RADS 3 lesions are often negative for PCa and that a more extensive sampling of the prostate (as it happens in targeted + systematic biopsies) may highlight undetected clinically significant (csPCa) disease areas at mpMRI.

Comparison between mpMRI, PB and WMA concerning csPCa areas. Paired data Student t test was performed to compare the average of mpMRI, PB, WMA positive areas in both groups. As shown in Table III, mpMRI detects fewer lesions than those later detected at PB and at WMA. That is true considering both TB and TSB; in TB group the results show an mpMRI number of lesions of 2.03 ± 1.22, a number of PB positive areas of 2.50 ± 1.34 and a number of WMA positive areas of 4.00 ± 1.53 (p<0.001 for all the comparisons); in TSB group the results show an mpMRI number of lesions of 1.90 ± 1.29, a number of PB positive areas of 3.35 ± 1.60 and a number of WMA positive areas of 4.27 ± 1.62 (p<0.001 for all the comparisons). This finding remains significant also stratifying by PI-RADS score (Table III).

The average percentage of mpMRI lesions compared with WMA is comparable in the two groups: in TB group mpMRI pointed out 53% of lesions later identified by WMA, in TSB group 47% (p= 0.139). A significant difference was found comparing the two biopsy approaches: TB was able to identify 64% of the csPCa lesions, TSB had a better result with a percentage of detected lesions of 80% (p<0.001). Our results suggest that mpMRI can point out about 50% of csPCa lesions and that is true in both groups. In contrast, there is a significant difference considering the two biopsy techniques when compared to WMA. This implies that the addition of systematic sampling may lead to a better local staging of the disease and its better spatial assessment.

Correlation between PCa Gleason Score and mpMRI PI-RADS score. Among patients who underwent to TB the correlation between PI-RADS score and Gleason Score (GS) at PB and at WMA is significant, but not as good as the spatial correlation: r=0,271 for the correlation between PI-RADS score and PB GS (p=0.012), r=0.353 for PI-RADS and WMA GS (p=0.001) and r=0,511 for PB GS and WMA GS (p<0.001). Similar outcomes were found in TSB group: Pearson’s r was 0,233 for the correlation between PI-RADS and WMA GS (p: 0,025) and 0,526 for PB GS and WMA GS (p< 0,001). In TSB group, correlation doesn’t reach the statistical significance comparing PI-RADS score and PB GS (Pearson’s r: 0,125, p: 0,235). This could mean that mpMRI can predict tumor aggressiveness (because as PI-RADS score increases, so does GS at PB and WMA), but its results are sub-optimal. In particular, for PI-RADS 3 lesions and for the correlation between PI-RADS and GS at PB and WMA, often revealed cases of tumor upgrading. In conclusion, by the addition of systematic biopsy samplings more tumor sites of different Gleason Score (both nsPCa and csPCa) can be identified independently from their exact location at mpMRI (Table IV).

The accuracy of mpMRI and MRI-targeted biopsy in the detection and localization of csPCa may be influenced by several factors. The European Society of Urogenital Radiology and the European Association of Urology section of Urologic Imaging recently participated in a Delphi consensus process regarding the potential role of mpMRI for the detection of PCa, stating its well-estabilished upfront role in the updated European Association of Urology guideline and the American Urological Association recommendations and the need of estabilished quality criteria for the image acquisition and reporting. [1,22].

Many of these quality criteria remain often disattended since different authors confirmed conflictual results for the characterization of csPCa sites by mpMRI .

Radtke et al and Baco et al in a retrospective analysis on patients who had undergone to radical prostatectomy for PCa found a significant correlation between the tumor sites located by mpMRI and whole mount specimens in 92 and 95% of cases respectively [23,24] . Conversely Tan et al and Laurenco et al. in similar studies found a 46.7% and 33.3% mpMRI sensitivity respectively [25,26].

However, the capability of mpMRI for the detection of csPCa sites likely depends not only by the proven experience of each single radiologist but also by other factors such as the tumor multifocality, the tumor volume and its pathological characteristics. Steenbergen and Di Campli showed as the interobserver variability may be considered as not a significant factor influencing the PCa tumor diagnosis whilst Riney showed conflicting results stating that the interobserver evaluation represents a relevant factor in the selection of the PIRADS classification [27-29].

According to our experience, mpMRI and prostate biopsy showed excellent results in terms of concordance for the characterization of csPCa in the case of previously diagnosed PIRADS 4 and 5 lesions whilst seems to be less accurate in the definition of PIRADS 3 lesions. On the other hand, independently from the agreement of the tumor sites clinically defined by mpMRI and WMA after radical prostatectomy, about 50% csPCa tumor sites resulted undetected at WMA independently from the biopsy technique adopted. In detail the interpretation of tumor sites may be easily failed by the radiologist also in the case of csPCa. These results confirmed those obtained by Lee in a retrospective study on patients with PCa who underwent to radical prostatectomy after mpMRI . [30]. They found 237 tumor sites at WMA out 107 patients with a sensitivity of 46% at mpMRI but a 75.5% and 77% of sensitivity and specificity respectively in the case of csPCa.

Similarly, Adhoot evidenced the effects of a cross sectional study comparing systematic biopsy to mpMRI targeted biopsies on a cohort of 2103 patients with clinical suspicion of PCa and found that mpMRI targeted biopsy alone (without systematic biopsy) would have led to no detection of ISUP≥2 cancers in 164 patients.[18]

Drost in a recent Cochrane metanalysis found that systematic biopsy was able to detect 4,3% of ISUP ≥ 2 and 2,8% of ISUP ≥ 3 PCa missed by targeted approach in biopsy naïve patients whilst it seems to be less accurate in the case of patients who underwent re-biopsy. [12]

Our results demonstrated that TSB correlates with WMA better than TB and or mpMRI in the complete definition of csPCa tumor sites. This implies that the addition of systematic sampling at targeted biopsy may lead to a better local staging of the disease, an improved spatial assessment with potential effects on the risk of developing positive margins at WMA after radical prostatectomy.

Similarly, we found a significant correlation between TB, PIRADS score and Gleason score at biopsy whilst the same comparison with TSB does not lead to significant results due to the increased risk of nsPCa. Statistically significant differences at the comparison of the Gleason score at prostate biopsy and at WMA in both the biopsy groups were also found.

Adhoot found comparable results in terms of diagnostic accuracy but mpMRI targeted biopsies showed more significant results in the Gleason score characterization although responsible for upgrading of events in 458 (21.8%) when combined to systematic biopsy. Differences in rates of upgrading between systematic and targeted biopsy were statistically significant.[18].

Limitations of the study

The use of different systems for targeted biopsies represents a relevant factor as well as the experience of each radiologist for the interpretation of data at mpMRI, although mpMRI of all the patients was revised by the intra/extra observer radiologist for the study follow up.

Systematic biopsy cores have been always taken according to a bi-planar evaluation and compared to the mpMRI which consists of a tri-planar evaluation. Thus, a precise template for systematic biopsy cores was adopted to obtain more homogeneous results.

The results obtained confirmed the good correlation between PIRADS 4 and 5 tumor site classification, targeted biopsies and whole mount histological analysis although about 50% of csPCa resulted undetected at WMA. The concomitant use of systematic core biopsy increases the likelihood of finding at least 80% of csPCa tumor sites at the expense of an increased the risk of about 20% upgrading. However, an accurate definition of tumor sites in the context of the prostate gland as revealed by WMA, represents a relevant issue for the local staging of PCa and may be of some help in avoiding the risk of positive margins at surgery.

Funding: this research did not receive external funding.

Conflict of interest: the authors declare no conflicts of interest.

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Table I. Pre-Surgery Demographic and Clinical Characteristics of the Patients.

Statistics: mean (sd) or frequency (%).

Characteristic	TSB group	TB group	p-value
Age (yrs)	70 (6.5)	69 (6.6)	0.197
BMI (kg/m²)	26.3 (3.1)	25.7 (3.7)	0.408
tPSA (ng/ml)	11.1 (8.6)	11.8 (7.9)	0.635
aaCCI	5.2 (1.1)	5.3 (1.3)	0.532
DRE			0.505
neg	65 (61.3)	53 (55.8)
pos	41 (38.7)	42 (44.2)
Smoking Habit			0.519
no	90 (84.9)	77 (81.1)
yes	16 (15.1)	18 (18.9)

Abbreviations: Targeted and Systematic Boipsy (TSB), Targeted Biopsy (TB), Body Mass Index (BMI), total Prostate Specific Antigen (tPSA), age adjusted Charlson Comorbidity Index (aaCCI), Digital Rectal Examination (DRE).

We found no significant differences in baseline characteristics.

Table II. Correlation analysis between mpMRI, PB and WMA stratified by group and by group and PI-RADS score.

		mpMRI ROIs	Biopsy positive areas	WMA
TB group
mpMRI ROIs	Pearson's r	1	0.718	0.546
mpMRI ROIs	p-value		<0.001	<0.001
Biopsy positive areas	Pearson's r	0.718	1	0.615
Biopsy positive areas	p-value	<0.001		<0.001
WMA	Pearson's r	0.546	0.615	1
WMA	p-value	<0.001	<0.001
TSB group
mpMRI ROIs	Pearson's r	1	0.425	0.441
mpMRI ROIs	p-value		<0.001	<0.001
Biopsy positive sectors	Pearson's r	0.425	1	0.704
Biopsy positive sectors	p-value	<0.001		<0.001
WMA	Pearson's r	0.441	0.704	1
WMA	p-value	<0.001	<0.001
			Biopsy positive areas	WMA
PI-RADS 5
TB group
mpMRI ROIs	Pearson's r		0.815	0.660
	p-value		<0.001	<0.001
TSB group
mpMRI ROIs	Pearson's r		0.560	0.533
	p-value		0.002	0.004

PI-RADS 4
TB group
mpMRI ROIs	Pearson's r		0.601	0.483
	p-value		<0.001	0.002
TSB group
mpMRI ROIs	Pearson's r		0.629	0.395
	p-value		<0.001	0.008

PI-RADS 3
TB group
mpMRI ROIs	Pearson's r		0.791	0.267
	p-value		<0.001	0.218
TSB group
mpMRI ROIs	Pearson's r		0.802	0.719
	p-value		0.002	0.008

Abbreviations: Multiparametric Magnetic Resonance (mpMRI), Region of Interest (ROI), Whole Mount Analysis (WMA), Targeted and Systematic Boipsy (TSB), Targeted Biopsy (TB).

Spatial correlation between mpMRI ROIs, PB positive areas and whole-mount analysis was found as good. Pearson’s correlation was good also stratifying different PI-RADS categories in both groups. The best correlation was found for PI-RADS 5 lesions in TB group. TSB has the best performance in PI-RADS 3 ROIs. Concerning PI-RADS 3 lesions, mpMRI does not correlate with WMA in TB group.

Table III. Paired data Student t test results stratified by prostate biopsy group and PI-RADS score.

	mean	sd	p-value
TB group
mpMRI ROIs (n°)	2.03	1.22	<0.001
WMA positive areas (n°)	4.00	1.53	<0.001
Biopsy positive areas (n°)	2.50	1.34	<0.001
WMA positive areas (n°)	4.00	1.53	<0.001
mpMRI ROIs (n°)	2.03	1.22	<0.001
Biopsy positive areas (n°)	2.50	1.34	<0.001
TSB group
mpMRI ROIs (n°)	1.90	1.29	<0.001
WMA positive areas (n°)	4.27	1.62	<0.001
Biopsy positive areas (n°)	3.35	1.60	<0.001
WMA positive areas (n°)	4.24	1.63	<0.001
mpMRI ROIs (n°)	1.90	1.29	<0.001
Biopsy positive areas (n°)	3.36	1.60	<0.001
PI-RADS 5
TB group
mpMRI ROIs (n°)	2.46	1.56	<0.001
WMA positive areas (n°)	4.83	1.81
mpMRI ROIs (n°)	2.46	1.56	0.005
Biopsy positive areas (n°)	3.04	1.49
TSB group
mpMRI ROIs (n°)	2.89	1.52	<0.001
WMA positive areas (n°)	5.07	1.56
mpMRI ROIs (n°)	2.89	1.52	0.003
Biopsy positive areas (n°)	3.89	1.85
PI-RADS 4
TB group
mpMRI ROIs (n°)	1.95	1.11	<0.001
WMA positive areas (n°)	3.68	1.28
mpMRI ROIs (n°)	1.95	1.11	0.031
Biopsy positive areas (n°)	2.37	1.40
TSB group
mpMRI ROIs (n°)	1.61	0.78	<0.001
WMA positive areas (n°)	3.91	1.46
mpMRI ROIs (n°)	1.61	0.78	<0.001
Biopsy positive areas (n°)	3.02	1.34
PI-RADS 3
TB group
mpMRI ROIs (n°)	1.78	0.90	<0.001
WMA positive areas (n°)	3.65	1.37
mpMRI ROIs (n°)	1.78	0.90	0.008
Biopsy positive areas (n°)	2.13	0.87
TSB group
mpMRI ROIs (n°)	1.58	0.90	<0.001
WMA positive areas (n°)	3.33	1.50
mpMRI ROIs (n°)	1.58	0.90	<0.001
Biopsy positive areas (n°)	2.58	1.00

Abbreviations: Multiparametric Magnetic Resonance (mpMRI), Region of Interest (ROI), Whole Mount Analysis (WMA), Targeted and Systematic Boipsy (TSB), Targeted Biopsy (TB).

mpMRI detects fewer lesions than those later detected at PB and at WMA in both groups. TB was able to point out about 64% of PCa lesions, whereas TSB 80% (p<0,001). That finding is significant also stratifying by PI-RADS score.

Table IV. Correlation between PI-RADS score and GS.

		PI-RADS	GS PB	GS WMA
TB group
PI-RADS	Pearson's r	1	0.271	0.353
PI-RADS	p-value		0.012	0.001
GS PB	Pearson's r	0.271	1	0.511
GS PB	p-value	0.012		<0.001
GS WMA	Pearson's r	0.353	0.511	1
GS WMA	p-value	0.001	<0.001

TSB group
PI-RADS	Pearson's r	1	0.125	0.233
PI-RADS	p-value		0.235	0.025
GS PB	Pearson's r	0.125	1	0.526
GS PB	p-value	0.235		<0.001
GS WMA	Pearson's r	0.233	0.526	1
GS WMA	p-value	0.025	<0.001

Abbreviations: Gleason Score (GS), Prostate Biopsy (PB), Targeted and Systematic Boipsy (TSB), Targeted Biopsy (TB), Whole Mount Analysis (WMA).

In TB group we found a significant correlation between PI-RADS score and GS at PB and WMA. Similar outcomes were found in TSB group, but in this group correlation doesn’t reach the statistical significance comparing PI-RADS score and PB GS.

There is NO conflict of interest to disclose.

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

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Abstract

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Introduction

Methods

Results

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

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