Decreased accuracy of the prostate cancer EAU risk group classification in the era of imaging-guided diagnostic pathway:
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ORIGINAL ARTICLE
Decreased accuracy of the prostate cancer EAU risk group classification in the era of imaging‑guided diagnostic pathway: proposal for a new classification based on MRI‑targeted biopsies and early oncologic outcomes after surgery Guillaume Ploussard1 · Cécile Manceau2,3 · Jean‑Baptiste Beauval1 · Marine Lesourd2,3 · Christophe Almeras1 · Jean‑Romain Gautier1 · Guillaume Loison1 · Ambroise Salin1 · Michel Soulié3 · Christophe Tollon1 · Bernard Malavaud2,3 · Mathieu Roumiguié2,3 Received: 18 November 2019 / Accepted: 6 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To assess the performance of EAU risk classification in PCa patients according to the biopsy pathway (standard versus MRI guided) and to develop a new, more accurate, targeted biopsy (TB)-based classification. Materials and methods We included 1345 patients consecutively operated by radical prostatectomy (RP) since 2014, when MRI and TB were introduced in the diagnostic pathway. Patients underwent systematic biopsy (SB) only (n = 819) or SB and TB (n = 526) prior to RP during the same time period. Pathological and biochemical outcomes were compared between PCa men undergoing SB (SB cohort) and a combination of TB and SB (TB cohort). Kaplan–Meier and Cox regression models were used to assess biochemical recurrence-free survival (RFS). Results Both cohorts were comparable regarding final pathology and RFS (p = 0.538). The EAU risk classification accurately predicted outcomes in SB cohort, but did not significantly separate low from intermediate risk in TB cohort (p = 0.791). In TB cohort, the new proposed three-group risk classification significantly improved the recurrence risk prediction compared with the EAU risk classification: HR 4 (versus HR 1.2, p = 0.009) for intermediate, and HR 15 (versus HR 6.5, p
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