Identifying cribriform and intraductal histology on magnetic resonance imaging-assisted biopsy for patients with intermediate-grade prostate cancer: Implications for active surveillance.

Abstract

Nearly 12% of patients in the United States with intermediate-risk prostate cancer (PCa) opt for surveillance as their initial management strategy. Patients with aggressive histologic variants, such as cribriform and intraductal carcinoma (IDC), are considered poor candidates for surveillance. The objective of this study was to determine the sensitivity and specificity of magnetic resonance imaging (MRI)-assisted biopsy for detecting cribriform PCa and IDC. In this retrospective cohort study, patients who underwent prostate MRI before biopsy within 6 months of prostatectomy at a single institution (2018-2024) were identified. All patients had grade group 2-3 (GG2-3) PCa on biopsy. The primary outcome was the sensitivity of MRI-assisted biopsy for detecting cribriform PCa and IDC by patient in the prostatectomy specimen. The authors identified 641 patients who had 1186 tumors that were GG2-3 PCa on biopsy. The median time between MRI and biopsy was 31 days, and the median time between biopsy and surgery was 91 days. Cribriform PCa was identified in 35 patients (5.5%) at the time of biopsy and in 119 patients (18.6%) at surgery. IDC was present in 22 patients (3.4%) at biopsy and in 71 patients (11.1%) at surgery. By patient, the sensitivity for detecting cribriform PCa, IDC, or either was 21.8%, 26.8%, and 29.3%, respectively. The sensitivity by tumor for cribriform PCa, IDC, or either was 20.5%, 27.3%, and 28%, respectively. The sensitivity of MRI-assisted biopsy for detecting cribriform PCa and IDC in patients with GG2-3 PCa is poor. This work should encourage improvements in detecting variant histologies with optimized biopsy, imaging, and adjunct biomarkers.