Session: MP61: Prostate Cancer: Localized: Surgical Therapy II
MP61-08: Prospective evaluation of radical prostatectomy without prior biopsy based on PSA, DRE, multiparametric magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography
Introduction: Modern imaging techniques are able to predict advanced prostate cancer with very high level of probability. This raises the question of omitting prostate biopsy as prerequisite for therapy. Here, we present a prospective study of patients undergoing radical prostatectomy without prior biopsy, based on DRE, PSA, PSMA-PET and mpMRI. Methods: Inclusion criteria were suspicious DRE and PSA value =10 ng/ml, high suspicion of prostate cancer on mpMRI (PI-RADS 4/5) and high suspicion of prostate cancer on PSMA-PET imaging (CT or MRI). Between March 2019-August 2022, 27 patients were included into the study (Group 1). After filing for an amendment that allowed to omit PSMA-PET imaging, six more patients were included (Group 2). Outside of the study, radical prostatectomy without prior biopsy was performed in carefully selected cases, who did not meet the inclusion criteria. (n = 17, group 3). Approved by the university clinic ethics committee (#19-693). Results: Group 1: In histology, 7/27 patients had ISUP 2, 10/27 had ISUP 3, 5/27 had ISUP 4 and 5/27 had ISUP 5. 1/27 patients had local tumor stage of pT2a, 9/27 had pT2c, 9/27 had pT3a and 8/27 had pT3b. Group 2: In histology, 3/6 patients had ISUP grade 2, 1/6 had ISUP grade 3, 2/6 had ISUP grade 5. 1/6 patients had local tumor stage pT2a, 2/6 had pT2c and 3/6 had pT3b. Group 3: All patients had abornmal PSA level+DRE. Median PSA was 7.06 ng/ml (IQR: 5.9 - 8.5). Suspicion of prostate cancer based on abnormal mpMRI in 15/17 patients and abnormal PSMA-PET imaging in 15/17 patients. 13/17 had suspicion of prostate cancer in both modalities. In histology, 4/17 patients had ISUP 1, 9/17 had ISUP grade 2, 3/17 patients had ISUP 3 and 1/17 had ISUP 5. 3/17 patients had local tumor stage of pT2a, 12/17 had pT2c and 2/17 had pT3b. Group 1+2 showed a significantly higher rate of locally advanced prostate cancer compared to Group 3 (pT3a/pT3b: 60.6% vs. 11.8%, p < 0.001). Group 1+2 showed a significantly higher rate of aggressive prostate cancer compared to group 3 (ISUP grade>2: 66.7% vs. 23.5%,p < 0.001). Conclusions: In this prospective study approved by the ethics committee, it was shown that radical prostatectomy without prior biopsy can be done finding significant cancer in every single patient. Applying the strict inclusion criteria, histology showed a very high rate of locally advanced prostate cancer. More studies are needed to further improve the inclusion criteria for radical prostatectomy without prior biopsy. SOURCE OF Funding: -
