Targeted Prostate Biopsy to Select Men for Active Surveillance: Do the Epstein Criteria Still Apply? The Journal of urology Hu, J. C., Chang, E. n., Natarajan, S. n., Margolis, D. J., Macairan, M. n., Lieu, P. n., Huang, J. n., Sonn, G. n., Dorey, F. J., Marks, L. S. 2014


The Epstein histologic criteria (Gleason score <6, <2 cores positive, <50% of any core), established in 1994, have been widely used to select men for active surveillance. However, with the advent of targeted biopsy, which may be more accurate than conventional biopsy, we re-evaluated the likelihood of re-classification upon confirmatory re-biopsy using multi-parametric MRI-ultrasound fusion (mpMRI-US).We identified 113 subjects enrolled in the UCLA active surveillance meeting Epstein Criteria who subsequently underwent confirmatory, targeted biopsy via mpMRI-US. Median age was 64 years, PSA 4.2 ng/ml and prostate volume 46.8 cc. Targets, or regions of interest on mpMRI, were graded by level of suspicion and were biopsied at 3 mm intervals along their longest axis (median 10.5 mm). Additionally, 12 systematic cores were obtained during confirmatory re-biopsy. Our reporting is consistent with START criteria.Overall, confirmatory fusion biopsy resulted in re-classification for 41 men (36%), 26 (23%) due to Gleason grade >6, and 15 (13%) due to high volume Gleason 6 disease. When stratified by suspicion on mpMRI, the likelihood of reclassification was 24% to 29% for men with target grade 0 to 3, 45% for grade 4, and 100% for grade 5 (p=0.001). Men with grade 4 and 5 versus lower grade targets were >3 times (Odds Ratio 3.2, 95% Confidence Interval 1.4, 7.1, p=0.006) more likely to be reclassified.Upon confirmatory re-biopsy using mpMRI-US, men with high-suspicion mpMRI targets were frequently reclassified (45%-100%). Criteria for active surveillance should be re-evaluated when mpMRI-guided prostate biopsy is employed.

View details for DOI 10.1016/j.juro.2014.02.005

View details for PubMedID 24512956