TY - JOUR

T1 - Re

T2 - Michael Baboudjian, Romain Diamand, Alessandro Uleri, et al. Does Overgrading on Targeted Biopsy of Magnetic Resonance Imaging–visible Lesions in Prostate Cancer Lead to Overtreatment? Eur Urol. In press. https://doi.org/10.1016/j.eururo.2024.02.003

AU - Stroomberg, Hein V.

AU - Brasso, Klaus

AU - Røder, Andreas

PY - 2024

Y1 - 2024

N2 - We would like to congratulate Badoudjian et al [1] on their recent interesting publication. The study investigated potential overtreatment due to use of magnetic resonance imaging (MRI) in the diagnostic pathway by comparing Gleason grade group (GG) on biopsy to GG for the radical prostatectomy (RP) specimen. Badoudjian et al conclude that the grade concordance between MRI-targeted biopsy and RP specimens is high and that because only 3.2% of cases were downgraded from GG ≥2 to GG 1, the risk of overtreatment with MRI is minimal. We would like to stress that comparisons of GG findings between biopsy and RP specimens are not informative for defining “overtreatment”. Overdiagnosis and overtreatment are terms describing men diagnosed or treated for a disease that is unlikely to develop into symptoms or death. This cannot be determined by comparing histological grades. The rapid uptake of new biopsy techniques, MRI fusion biopsies, and oversampling of small MRI targets could lead us into a new era of overdiagnosis whereby small indolent tumors otherwise missed by “blind” systematic biopsies are now diagnosed and treated as “clinically significant prostate cancer”. The GG remains the sum of grades without anything to substantiate its biology or lethality. Therefore, the definition of “clinically significant” has been massively inflated since the introduction of MRI and is now, rightly, under discussion. “Overtreatment” should be restrained to defining which men underwent treatment that did not reduce symptoms or death from the disease to its comparator.

AB - We would like to congratulate Badoudjian et al [1] on their recent interesting publication. The study investigated potential overtreatment due to use of magnetic resonance imaging (MRI) in the diagnostic pathway by comparing Gleason grade group (GG) on biopsy to GG for the radical prostatectomy (RP) specimen. Badoudjian et al conclude that the grade concordance between MRI-targeted biopsy and RP specimens is high and that because only 3.2% of cases were downgraded from GG ≥2 to GG 1, the risk of overtreatment with MRI is minimal. We would like to stress that comparisons of GG findings between biopsy and RP specimens are not informative for defining “overtreatment”. Overdiagnosis and overtreatment are terms describing men diagnosed or treated for a disease that is unlikely to develop into symptoms or death. This cannot be determined by comparing histological grades. The rapid uptake of new biopsy techniques, MRI fusion biopsies, and oversampling of small MRI targets could lead us into a new era of overdiagnosis whereby small indolent tumors otherwise missed by “blind” systematic biopsies are now diagnosed and treated as “clinically significant prostate cancer”. The GG remains the sum of grades without anything to substantiate its biology or lethality. Therefore, the definition of “clinically significant” has been massively inflated since the introduction of MRI and is now, rightly, under discussion. “Overtreatment” should be restrained to defining which men underwent treatment that did not reduce symptoms or death from the disease to its comparator.

U2 - 10.1016/j.eururo.2024.04.033

DO - 10.1016/j.eururo.2024.04.033

M3 - Letter

C2 - 38749855

AN - SCOPUS:85194532468

JO - European Urology (Italian Edition)

JF - European Urology (Italian Edition)

SN - 1828-6569

ER -