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Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
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Risk-Stratified Gleason Upgrading in ISUP Grade Group 1 Prostate Cancer: Combined Analysis of TMPRSS2-ERG, PTEN,
Nursinem Alkan Vurğun1, Nilay Şen Türk1, Sercan Vurğun2
1Department of Medical Pathology, Pamukkale University, Denizli, Turkey.
Summary
Molecular and imaging markers like ERG expression and PI-RADS scores can predict pathological upgrading in low-grade prostate cancer (ISUP GG1). This helps refine risk stratification and avoid overtreatment for patients undergoing radical prostatectomy.
Area of Science:
- Oncology
- Pathology
- Radiology
Background:
- Prostate cancer (PCa) management involves risk stratification for ISUP Grade Group 1 (GG1) cases.
- Pathological upgrading in GG1 PCa can lead to overtreatment.
- Identifying predictive biomarkers is crucial for accurate risk assessment.
Purpose of the Study:
- To evaluate molecular, immunohistochemical, and radiological parameters for predicting pathological upgrading in ISUP GG1 prostate cancer patients.
- To assess the association of PTEN, ERG, Ki-67, TMPRSS2-ERG fusion, PI-RADS, and ADC values with pathological upgrading.
Main Methods:
- Retrospective analysis of 106 GG1 prostate adenocarcinoma patients treated with radical prostatectomy (RP).
- Evaluation of biopsy specimens for PTEN, ERG, Ki-67 expression, and TMPRSS2-ERG fusion.
- Assessment of preoperative multiparametric MRI parameters including PI-RADS v2.1 scores and ADC values (ADCtumor, ADCratio).
Main Results:
- TMPRSS2-ERG fusion positivity and elevated ERG expression were significantly associated with high-risk upgrading.
- PI-RADS scores increased stepwise, and ADCtumor values decreased across risk groups.
- No significant differences were found for PTEN loss, Ki-67 index, or ADCratio.
Conclusions:
- Immunohistochemical, radiological, and molecular markers can predict pathological upgrading in GG1 prostate cancer.
- These biomarkers may aid in refining risk stratification and preventing overtreatment.
- ADCtumor values showed association with upgrading, but not with specific molecular markers.
