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New England Section of the American Urological Association

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Association of High-Grade Prostatic Intraepithelial Neoplasia, Atypical Small Acinar Proliferation, or Perineural Invasion with the Risk of Upgrading in Active Surveillance Cohort in the MRI-Ultrasound Fusion Biopsy Era
Ghazal Khajir, MD1, Kamyar Ghabili, MD1, Olayemi Olubowale, BS2, Michael S. Leapman, MD1, Angelique W. Levi, MD1, Peter A. Humphrey, MD, PhD1, Preston C. Sprenkle, MD1.
1Yale school of medicine, New Haven, CT, USA, 2Tulane University, New Orleans, LA, USA.

BACKGROUND: The role of high-grade prostatic intraepithelial neoplasia (HGPIN), atypical small acinar proliferation (ASAP), or perineural invasion (PNI) on the risk of upgrading in subsequent MRI-ultrasound fusion biopsies has not been well studied. We aimed to determine if the presence of those pathological characteristics on prostate biopsy increases the risk of upgrading on subsequent MRI-ultrasound fusion biopsy for active surveillance (AS). METHODS: We retrospectively queried an institutional MRI-ultrasound fusion prostate biopsy database to identify men in AS for grade group (GG) 1 prostate cancer. Upgrading in AS cohort was defined as pathological progression from GG1 on initial biopsy to GG 2 or greater on subsequent biopsy between January 2013 and February 2019. Binary logistic regression was performed to identify clinical, radiological, and biopsy pathological features (HGPIN, ASAP, or PNI) associated with the presence of upgrading on surveillance biopsy. RESULTS: Our AS cohort included 127 men; 101 (79.5%) and 93 (73.2%) had region(s) of interest on initial and subsequent prostate MRIs, respectively, and therefore underwent MRI-ultrasound fusion biopsy. Among men on AS, 31 (24.4%) showed upgrading on subsequent biopsy. Although HGPIN was associated with upgrading among patients on AS in univariate analysis (p=0.01), there was no independent significance in multivariable analysis (OR 3.84, 95%CI 0.60-24.63, p=0.15). Age (OR 1.07, 95%CI 1.001-1.15, p=0.04) and PI-RADS (4-5 versus 2-3, OR 2.89, 95%CI 1.14-7.35, p=0.02) remained significantly associated with an increased risk of upgrading on subsequent biopsy in men on AS (Table 1). CONCLUSIONS: No association was found between any of the studied pathological features (HGPIN, ASAP, or PNI) and upgrading on subsequent biopsy in AS cohort. Therefore, the presence of HGPIN, ASAP, or PNI on biopsy should not influence the management of men undergoing AS in the MRI-ultrasound fusion biopsy era.

Logistic regression models for the prediction of upgrading on subsequent biopsy in men on AS
UnivariateMultivariate
OR95%CIP valueOR95%CIP value
ASAP5.030.80-31.650.083.420.26-44.550.34
HGPIN9.031.65-49.290.013.840.60-24.630.15
PNI2.690.67-10.750.16
More than 2 of above pathologic features2.130.34-13.420.41
Age1.071.01-1.140.021.071.001-1.150.04
PI-RADS 4-53.271.36-7.860.0082.891.14-7.350.02
PSA density (per 0.1 unit)1.851.08-3.150.021.700.93-3.090.08


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