'Stealth' Prostate Tumors.

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Prostate cancer (PCa) diagnosis relies on prebiopsy imaging and biopsies.
• False negative results can lead to delayed or missed diagnoses.

Purpose of the Study:

• To determine the false negative rates of prebiopsy MRI and MRI-ultrasound (US) guided 12-core systematic prostate biopsy (PBx).
• To analyze radical prostatectomy specimens to assess diagnostic accuracy.

Main Methods:

• Retrospective analysis of 3600 prostate cancer patients undergoing robot-assisted radical prostatectomy.
• Patients were categorized based on biopsy and MRI findings: contralateral benign PBx, non-suspicious mpMRI, or both.
• Evaluated for PCa, clinically significant PCa (csPCa), extracapsular extension (ECE), and positive surgical margins (PSM).

Main Results:

• PCa detection rates varied across subgroups (19.5%–37.7%), with csPCa rates ranging from 10.3%–16.3%.
• Contralateral pT3 disease and positive surgical margins were observed in 4-7% of cases across subgroups.

Conclusions:

• Standard diagnostic methods for PCa exhibit significant false negative rates.
• Further strategies are essential to improve diagnostic accuracy and precise tumor localization.