Table Info

Table 3.

Included studies: pre-biopsy imaging

Authors	Year	Study design	Participants	Study outcomes associated with Gleason upgrading
Pham et al. [43]	2020	Retrospective case-control	377 patients with biopsy GS 3+4 who underwent robot-assisted laparoscopic RP from 2014 to 2018	Older age, elevated PSA, elevated PSAD, PI-RADSv2 score 4–5
Kim et al. [60]	2021	Retrospective case-control	539 patients undergoing RP for biopsy GS 3 + 4 PCa from two tertiary referral centers	Older age, higher PSA, PI-RADS lesion ≥ 4
Song et al. [62]	2018	Retrospective case-control	443 patients who underwent magnetic resonance imaging (MRI) and RP for biopsy-proven GS6 PCa between January 2011 and December 2013	PSAD density > 0.16 ng/mL², number of positive cores ≥ 2, maximum percentage of cancer per core > 20, PIRADSv2 lesion ≥ 4
Kamrava et al. [61]	2015	Retrospective case-control	245 men with a diagnosis of low-risk PCa	PI-RADSv2 5 lesion
Alqahtani et al. [6]	2020	Retrospective case-control	330 men treated with RP between July 2014 and January 2019	Increasing PI-RADSv2 score

RP: radical prostatectomy; PSAD: PSA density; PSA: prostate-specific antigen; PI-RADSv2: Prostate Imaging-Reporting and Data System version 2

Declarations

Author contributions

SS, VS, SDL and AUC: Conceptualization, Writing—original draft. JC, JB, JR and PS: Writing—review & editing. MSL: Conceptualization, Methodology, Writing—original draft, Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

References

Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74:12–49. [DOI] [PubMed]

Ferraro S, Biganzoli D, Rossi RS, Palmisano F, Bussetti M, Verzotti E, et al. Individual risk prediction of high grade prostate cancer based on the combination between total prostate-specific antigen (PSA) and free to total PSA ratio. Clin Chem Lab Med. 2023;61:1327–34. [DOI] [PubMed]

Frangioni JV. New technologies for human cancer imaging. J Clin Oncol. 2008;26:4012–21. [DOI] [PubMed] [PMC]

Pulumati A, Pulumati A, Dwarakanath BS, Verma A, Papineni RVL. Technological advancements in cancer diagnostics: Improvements and limitations. Cancer Rep (Hoboken). 2023;6:e1764. [DOI] [PubMed] [PMC]

Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, et al. Early detection of prostate cancer: AUA Guideline. J Urol. 2013;190:419–26. [DOI] [PubMed] [PMC]

Alqahtani S, Wei C, Zhang Y, Szewczyk-Bieda M, Wilson J, Huang Z, et al. Prediction of prostate cancer Gleason score upgrading from biopsy to radical prostatectomy using pre-biopsy multiparametric MRI PIRADS scoring system. Sci Rep. 2020;10:7722. [DOI] [PubMed] [PMC]

Meng X, Rosenkrantz AB, Mendhiratta N, Fenstermaker M, Huang R, Wysock JS, et al. Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion-targeted Prostate Biopsy Outcomes. Eur Urol. 2016;69:512–7. [DOI] [PubMed] [PMC]

Pinto PA, Chung PH, Rastinehad AR, Jr AAB, Kruecker J, Benjamin CJ, et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 2011;186:1281–5. [DOI] [PubMed] [PMC]

Streicher J, Meyerson BL, Karivedu V, Sidana A. A review of optimal prostate biopsy: indications and techniques. Ther Adv Urol. 2019;11:1–8. [DOI] [PubMed] [PMC]

10.

Budäus L, Graefen M, Salomon G, Isbarn H, Lughezzani G, Sun M, et al. The novel nomogram of Gleason sum upgrade: possible application for the eligible criteria of low dose rate brachytherapy. Int J Urol. 2010;17:862–8. [DOI] [PubMed]

11.

Leenders GJLHv, Kwast THvd, Grignon DJ, Evans AJ, Kristiansen G, Kweldam CF, et al. The 2019 International Society of Urological Pathology (ISUP) Consensus Conference on Grading of Prostatic Carcinoma. Am J Surg Pathol. 2020;44:e87–99. [DOI] [PubMed] [PMC]

12.

Sved PD, Gomez P, Manoharan M, Kim SS, Soloway MS. Limitations of biopsy Gleason grade: implications for counseling patients with biopsy Gleason score 6 prostate cancer. J Urol. 2004;172:98–102. [DOI] [PubMed]

13.

Corcoran NM, Hong MKH, Casey RG, Hurtado-Coll A, Peters J, Harewood L, et al. Upgrade in Gleason score between prostate biopsies and pathology following radical prostatectomy significantly impacts upon the risk of biochemical recurrence. BJU Int. 2011;108:E202–10. [DOI] [PubMed]

14.

Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC. Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer. 2007;121:1571–8. [DOI] [PubMed] [PMC]

15.

Leitzmann MF, Rohrmann S. Risk factors for the onset of prostatic cancer: age, location, and behavioral correlates. Clin Epidemiol. 2012;4:1–11. [DOI] [PubMed] [PMC]

16.

Leeman JE, Chen M, Huland H, Graefen M, D’Amico AV, Tilki D. Advancing Age and the Odds of Upgrading and Upstaging at Radical Prostatectomy in Men with Gleason Score 6 Prostate Cancer. Clin Genitourin Cancer. 2019;17:E1116–21. [DOI] [PubMed]

17.

Gershman B, Dahl DM, Olumi AF, Young RH, McDougal WS, Wu C. Smaller prostate gland size and older age predict Gleason score upgrading. Urol Oncol. 2013;31:1033–7. [DOI] [PubMed]

18.

Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol. 2012;61:1019–24. [DOI] [PubMed] [PMC]

19.

Mazzone E, Stabile A, Sorce G, Pellegrino F, Barletta F, Motterle G, et al. Age and gleason score upgrading between prostate biopsy and radical prostatectomy: Is this still true in the multiparametric resonance imaging era? Urol Oncol. 2021;39:784.e1–9. [DOI] [PubMed]

20.

Vora A, Large T, Aronica J, Haynes S, Harbin A, Marchalik D, et al. Predictors of Gleason score upgrading in a large African-American population. Int Urol Nephrol. 2013;45:1257–62. [DOI] [PubMed]

21.

Freedland SJ, Kane CJ, Amling CL, Aronson WJ, Terris MK, Jr JCP, et al.; SEARCH Database Study Group. Upgrading and downgrading of prostate needle biopsy specimens: risk factors and clinical implications. Urology. 2007;69:495–9. [DOI] [PubMed] [PMC]

22.

Zheng T, Sun H, Tang Y, Bi K, Zeng Y, Wang J, et al. Comparing histology between prostate cognitive fusion targeted biopsy and radical prostatectomy: exploring risk factors of Gleason score upgrading in Chinese patients. J Cancer Res Clin Oncol. 2023;149:18029–37. [DOI] [PubMed]

23.

Hu M, Liu S, Jiang H, Bai P, Ding Q. Obesity affects the biopsy-mediated detection of prostate cancer, particularly high-grade prostate cancer: a dose-response meta-analysis of 29,464 patients. PLoS One. 2014;9:e106677. [DOI] [PubMed] [PMC]

24.

Travis RC, Appleby PN, Martin RM, Holly JMP, Albanes D, Black A, et al. A Meta-analysis of Individual Participant Data Reveals an Association between Circulating Levels of IGF-I and Prostate Cancer Risk. Cancer Res. 2016;76:2288–300. [DOI] [PubMed] [PMC]

25.

Paschos A, Pandya R, Duivenvoorden WCM, Pinthus JH. Oxidative stress in prostate cancer: changing research concepts towards a novel paradigm for prevention and therapeutics. Prostate Cancer Prostatic Dis. 2013;16:217–25. [DOI] [PubMed]

26.

Sundi D, Ross AE, Humphreys EB, Han M, Partin AW, Carter HB, et al. African American men with very low-risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: should active surveillance still be an option for them? J Clin Oncol. 2013;31:2991–7. [DOI] [PubMed] [PMC]

27.

Yang DD, Mahal BA, Muralidhar V, Nezolosky MD, Vastola ME, Labe SA, et al. Risk of Upgrading and Upstaging Among 10 000 Patients with Gleason 3+4 Favorable Intermediate-risk Prostate Cancer. Eur Urol Focus. 2019;5:69–76. [DOI] [PubMed]

28.

Dinh KT, Mahal BA, Ziehr DR, Muralidhar V, Chen Y, Viswanathan VB, et al. Incidence and Predictors of Upgrading and Up Staging among 10,000 Contemporary Patients with Low Risk Prostate Cancer. J Urol. 2015;194:343–9. [DOI] [PubMed]

29.

Jr JWL, Moses KA, Mahal BA, George DJ. Racial disparities in Black men with prostate cancer: A literature review. Cancer. 2022;128:3787–95. [DOI] [PubMed] [PMC]

30.

Uzzo RG, Wei JT, Waldbaum RS, Perlmutter AP, Byrne JC, Jr EDV. The influence of prostate size on cancer detection. Urology. 1995;46:831–6. [DOI] [PubMed]

31.

Kulkarni GS, Al-Azab R, Lockwood G, Toi A, Evans A, Trachtenberg J, et al. Evidence for a biopsy derived grade artifact among larger prostate glands. J Urol. 2006;175:505–9. [DOI] [PubMed]

32.

Kim KH, Lim SK, Shin T, Lee JY, Chung BH, Rha KH, et al. Upgrading of Gleason score and prostate volume: a clinicopathological analysis. BJU Int. 2013;111:1310–6. [DOI] [PubMed]

33.

Davies JD, Aghazadeh MA, Phillips S, Salem S, Chang SS, Clark PE, et al. Prostate size as a predictor of Gleason score upgrading in patients with low risk prostate cancer. J Urol. 2011;186:2221–7. [DOI] [PubMed]

34.

Pierorazio PM, Kinnaman MD, Wosnitzer MS, Benson MC, McKiernan JM, Goluboff ET. Prostate volume and pathologic prostate cancer outcomes after radical prostatectomy. Urology. 2007;70:696–701. [DOI] [PubMed]

35.

Freedland SJ, Isaacs WB, Platz EA, Terris MK, Aronson WJ, Amling CL, et al. Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol. 2005;23:7546–54. [DOI] [PubMed]

36.

Davidson DD, Koch MO, Lin H, Jones TD, Biermann K, Cheng L. Does the size matter? Am J Clin Pathol. 2010;133:662–8. [DOI] [PubMed]

37.

Luo J, Duggan DJ, Chen Y, Sauvageot J, Ewing CM, Bittner ML, et al. Human prostate cancer and benign prostatic hyperplasia: molecular dissection by gene expression profiling. Cancer Res. 2001;61:4683–8. [PubMed]

38.

D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Tomaszewski JE, Wein A. A prostate gland volume of more than 75 cm³ predicts for a favorable outcome after radical prostatectomy for localized prostate cancer. Urology. 1998;52:631–6. [DOI] [PubMed]

39.

Etzioni R, Tsodikov A, Mariotto A, Szabo A, Falcon S, Wegelin J, et al. Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control. 2008;19:175–81. [DOI] [PubMed] [PMC]

40.

Mehta V, Rycyna K, Baesens BMM, Barkan GA, Paner GP, Flanigan RC, et al. Predictors of Gleason Score (GS) upgrading on subsequent prostatectomy: a single Institution study in a cohort of patients with GS 6. Int J Clin Exp Pathol. 2012;5:496–502. [PubMed] [PMC]

41.

Hong SK, Han BK, Lee ST, Kim SS, Min KE, Jeong SJ, et al. Prediction of Gleason score upgrading in low-risk prostate cancers diagnosed via multi (≥12)-core prostate biopsy. World J Urol. 2009;27:271–6. [DOI] [PubMed]

42.

Benson MC, Whang IS, Pantuck A, Ring K, Kaplan SA, Olsson CA, et al. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol. 1992;147:815–6. [DOI] [PubMed]

43.

Pham DM, Kim JK, Lee S, Hong SK, Byun S, Lee SE. Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? Investig Clin Urol. 2020;61:405–10. [DOI] [PubMed] [PMC]

44.

Maruyama Y, Sadahira T, Araki M, Mitsui Y, Wada K, Rodrigo AGH, et al. Factors predicting pathological upgrading after prostatectomy in patients with Gleason grade group 1 prostate cancer based on opinion-matched biopsy specimens. Mol Clin Oncol. 2020;12:384–9. [DOI] [PubMed] [PMC]

45.

Corcoran NM, Casey RG, Hong MKH, Pedersen J, Connolly S, Peters J, et al. The ability of prostate-specific antigen (PSA) density to predict an upgrade in Gleason score between initial prostate biopsy and prostatectomy diminishes with increasing tumour grade due to reduced PSA secretion per unit tumour volume. BJU Int. 2012;110:36–42. [DOI] [PubMed]

46.

Lai WS, Gordetsky JB, Thomas JV, Nix JW, Rais-Bahrami S. Factors predicting prostate cancer upgrading on magnetic resonance imaging–targeted biopsy in an active surveillance population. Cancer. 2017;123:1941–8. [DOI] [PubMed]

47.

Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998;279:1542–7. [DOI] [PubMed]

48.

Visapää H, Hotakainen K, Lundin J, Ala-Opas M, Stenman U. The proportion of free PSA and upgrading of biopsy Gleason score after radical prostatectomy. Urol Int. 2010;84:378–81. [DOI] [PubMed]

49.

Catalona WJ, Partin AW, Sanda MG, Wei JT, Klee GG, Bangma CH, et al. A multicenter study of [-2]pro-prostate specific antigen combined with prostate specific antigen and free prostate specific antigen for prostate cancer detection in the 2. J Urol. 2011;185:1650–5. [DOI] [PubMed] [PMC]

50.

Kim H, Jung G, Kim JH, Byun S, Hong SK. Role of prostate health index to predict Gleason score upgrading and high-risk prostate cancer in radical prostatectomy specimens. Sci Rep. 2021;11:17447. [DOI] [PubMed] [PMC]

51.

Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:dju124. [DOI] [PubMed]

52.

Soest RJv, Templeton AJ, Vera-Badillo FE, Mercier F, Sonpavde G, Amir E, et al. Neutrophil-to-lymphocyte ratio as a prognostic biomarker for men with metastatic castration-resistant prostate cancer receiving first-line chemotherapy: data from two randomized phase III trials. Ann Oncol. 2015;26:743–9. [DOI] [PubMed]

53.

Gokce MI, Tangal S, Hamidi N, Suer E, Ibis MA, Beduk Y. Role of neutrophil-to-lymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance. Can Urol Assoc J. 2016;10:E383–7. [DOI] [PubMed] [PMC]

54.

Ferro M, Musi G, Serino A, Cozzi G, Mistretta FA, Costa B, et al. Neutrophil, Platelets, and Eosinophil to Lymphocyte Ratios Predict Gleason Score Upgrading in Low-Risk Prostate Cancer Patients. Urol Int. 2019;102:43–50. [DOI] [PubMed]

55.

Botto H, Neuzillet Y, Lebret T, Camparo P, Molinie V, Raynaud J. High incidence of predominant Gleason pattern 4 localized prostate cancer is associated with low serum testosterone. J Urol. 2011;186:1400–5. [DOI] [PubMed]

56.

Schatzl G, Madersbacher S, Thurridl T, Waldmüller J, Kramer G, Haitel A, et al. High-grade prostate cancer is associated with low serum testosterone levels. Prostate. 2001;47:52–8. [DOI] [PubMed]

57.

Pichon A, Neuzillet Y, Botto H, Raynaud J, Radulescu C, Molinié V, et al. Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading. Prostate Cancer Prostatic Dis. 2015;18:382–7. [DOI] [PubMed]

58.

Park SY, Jung DC, Oh YT, Cho NH, Choi YD, Rha KH, et al. Prostate Cancer: PI-RADS Version 2 Helps Preoperatively Predict Clinically Significant Cancers. Radiology. 2016;280:108–16. [DOI] [PubMed]

59.

Brembilla G, Dell’Oglio P, Stabile A, Ambrosi A, Cristel G, Brunetti L, et al. Preoperative multiparametric MRI of the prostate for the prediction of lymph node metastases in prostate cancer patients treated with extended pelvic lymph node dissection. Eur Radiol. 2018;28:1969–76. [DOI] [PubMed]

60.

Kim H, Kim JK, Hong SK, Jeong CW, Ku JH, Kwak C. Role of multiparametric magnetic resonance imaging to predict postoperative Gleason score upgrading in prostate cancer with Gleason score 3 + 4. World J Urol. 2021;39:1825–30. [DOI] [PubMed]

61.

Kamrava M, Kishan AU, Margolis DJ, Huang J, Dorey F, Lieu P, et al. Multiparametric magnetic resonance imaging for prostate cancer improves Gleason score assessment in favorable risk prostate cancer. Pract Radiat Oncol. 2015;5:411–6. [DOI] [PubMed] [PMC]

62.

Song W, Bang SH, Jeon HG, Jeong BC, Seo SI, Jeon SS, et al. Role of PI-RADS Version 2 for Prediction of Upgrading in Biopsy-Proven Prostate Cancer With Gleason Score 6. Clin Genitourin Cancer. 2018;16:281–7. [DOI] [PubMed]

63.

Seisen T, Roudot-Thoraval F, Bosset PO, Beaugerie A, Allory Y, Vordos D, et al. Predicting the risk of harboring high-grade disease for patients diagnosed with prostate cancer scored as Gleason ≤ 6 on biopsy cores. World J Urol. 2015;33:787–92. [DOI] [PubMed]

64.

San Francisco IF, DeWolf WC, Rosen S, Upton M, Olumi AF. Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy. J Urol. 2003;169:136–40. [DOI] [PubMed]

65.

Ploussard G, Xylinas E, Salomon L, Allory Y, Vordos D, Hoznek A, et al. The role of biopsy core number in selecting prostate cancer patients for active surveillance. Eur Urol. 2009;56:891–8. [DOI] [PubMed]

66.

Numao N, Kawakami S, Yokoyama M, Yonese J, Arisawa C, Ishikawa Y, et al. Improved accuracy in predicting the presence of Gleason pattern 4/5 prostate cancer by three-dimensional 26-core systematic biopsy. Eur Urol. 2007;52:1663–8. [DOI] [PubMed]

67.

Arsov C, Becker N, Rabenalt R, Hiester A, Quentin M, Dietzel F, et al. The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy. J Cancer Res Clin Oncol. 2015;141:2061–8. [DOI] [PubMed]

68.

Taira AV, Merrick GS, Galbreath RW, Andreini H, Taubenslag W, Curtis R, et al. Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting. Prostate Cancer Prostatic Dis. 2010;13:71–7. [DOI] [PubMed] [PMC]

69.

Fu Q, Moul JW, Bañez LL, Sun L, Mouraviev V, Xie D, et al. Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer. Med Oncol. 2012;29:3339–44. [DOI] [PubMed]

70.

Truong M, Slezak JA, Lin CP, Iremashvili V, Sado M, Razmaria AA, et al. Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer. Cancer. 2013;119:3992–4002. [DOI] [PubMed] [PMC]

71.

Sarici H, Telli O, Yigitbasi O, Ekici M, Ozgur BC, Yuceturk CN, et al. Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6. Can Urol Assoc J. 2014;8:E342–6. [DOI] [PubMed] [PMC]

72.

Athanazio D, Gotto G, Shea-Budgell M, Yilmaz A, Trpkov K. Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade. Histopathology. 2017;70:1098–106. [DOI] [PubMed]

73.

Evans SM, Bandarage VP, Kronborg C, Earnest A, Millar J, Clouston D. Gleason group concordance between biopsy and radical prostatectomy specimens: A cohort study from Prostate Cancer Outcome Registry - Victoria. Prostate Int. 2016;4:145–51. [DOI] [PubMed] [PMC]

74.

Zhang B, Wu S, Zhang Y, Guo M, Liu R. Analysis of risk factors for Gleason score upgrading after radical prostatectomy in a Chinese cohort. Cancer Med. 2021;10:7772–80. [DOI] [PubMed] [PMC]

75.

Cooperberg MR, Broering JM, Kantoff PW, Carroll PR. Contemporary trends in low risk prostate cancer: risk assessment and treatment. J Urol. 2007;178:S14–9. [DOI] [PubMed] [PMC]

76.

Shao Y, Demissie K, Shih W, Mehta AR, Stein MN, Roberts CB, et al. Contemporary risk profile of prostate cancer in the United States. J Natl Cancer Inst. 2009;101:1280–3. [DOI] [PubMed] [PMC]

77.

D’Amico AV, Renshaw AA, Arsenault L, Schultz D, Richie JP. Clinical predictors of upgrading to Gleason grade 4 or 5 disease at radical prostatectomy: potential implications for patient selection for radiation and androgen suppression therapy. Int J Radiat Oncol Biol Phys. 1999;45:841–6. [DOI] [PubMed]

78.

Lanz C, Cornud F, Beuvon F, Lefèvre A, Legmann P, Zerbib M, et al. Gleason Score Determination with Transrectal Ultrasound-Magnetic Resonance Imaging Fusion Guided Prostate Biopsies—Are We Gaining in Accuracy? J Urol. 2016;195:88–93. [DOI] [PubMed]

79.

Fine SW, Epstein JI. A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score. J Urol. 2008;179:1335–9. [DOI] [PubMed]

80.

Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al.; PRECISION Study Group Collaborators. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378:1767–77. [DOI] [PubMed] [PMC]

81.

Mesko S, Marks L, Ragab O, Patel S, Margolis DA, Demanes DJ, et al. Targeted Prostate Biopsy Gleason Score Heterogeneity and Implications for Risk Stratification. Am J Clin Oncol. 2018;41:497–501. [DOI] [PubMed] [PMC]

82.

Yu A, Yamany T, Mojtahed A, Hanna N, Nicaise E, Harisinghani M, et al. Combination MRI-targeted and systematic prostate biopsy may overestimate gleason grade on final surgical pathology and impact risk stratification. Urol Oncol. 2022;40:59.e1–5. [DOI] [PubMed]

83.

Ghai S, Eure G, Fradet V, Hyndman ME, McGrath T, Wodlinger B, et al. Assessing Cancer Risk on Novel 29 MHz Micro-Ultrasound Images of the Prostate: Creation of the Micro-Ultrasound Protocol for Prostate Risk Identification. J Urol. 2016;196:562–9. [DOI] [PubMed]

84.

Hofbauer SL, Luger F, Harland N, Plage H, Reimann M, Hollenbach M, et al. A non-inferiority comparative analysis of micro-ultrasonography and MRI-targeted biopsy in men at risk of prostate cancer. BJU Int. 2022;129:648–54. [DOI] [PubMed]

85.

Lughezzani G, Saita A, Lazzeri M, Paciotti M, Maffei D, Lista G, et al. Comparison of the Diagnostic Accuracy of Micro-ultrasound and Magnetic Resonance Imaging/Ultrasound Fusion Targeted Biopsies for the Diagnosis of Clinically Significant Prostate Cancer. Eur Urol Oncol. 2019;2:329–32. [DOI] [PubMed]

86.

Socarrás MER, Rivas JG, Rivera VC, Elbers JR, González LL, Mercado IM, et al. Prostate Mapping for Cancer Diagnosis: The Madrid Protocol. J Urol. 2020;204:726–33. [DOI] [PubMed]

87.

Lughezzani G, Maffei D, Saita A, Paciotti M, Diana P, Buffi NM, et al. Diagnostic Accuracy of Microultrasound in Patients with a Suspicion of Prostate Cancer at Magnetic Resonance Imaging: A Single-institutional Prospective Study. Eur Urol Focus. 2021;7:1019–26. [DOI] [PubMed]

88.

Klotz L, Lughezzani G, Maffei D, Sánchez A, Pereira JG, Staerman F, et al. Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: A multicenter, prospective analysis. Can Urol Assoc J. 2021;15:E11–6. [DOI] [PubMed] [PMC]

89.

Klotz L, Andriole G, Cash H, Cooperberg M, Crawford ED, Emberton M, et al. Optimization of prostate biopsy - Micro-Ultrasound versus MRI (OPTIMUM): A 3-arm randomized controlled trial evaluating the role of 29 MHz micro-ultrasound in guiding prostate biopsy in men with clinical suspicion of prostate cancer. Contemp Clin Trials. 2022;112:106618. [DOI] [PubMed]

90.

Jairath NK, Pra AD, Jr RV, Dess RT, Jackson WC, Tosoian JJ, et al. A Systematic Review of the Evidence for the Decipher Genomic Classifier in Prostate Cancer. Eur Urol. 2021;79:374–83. [DOI] [PubMed]

91.

Press BH, Jones T, Olawoyin O, Lokeshwar SD, Rahman SN, Khajir G, et al. Association Between a 22-feature Genomic Classifier and Biopsy Gleason Upgrade During Active Surveillance for Prostate Cancer. Eur Urol Open Sci. 2022;37:113–9. [DOI] [PubMed] [PMC]

92.

Sheng J, Vetter J, Barashi N, McGinnis JR, Kim E. DECIPHER® GENOMIC CLASSIFIER ON INITIAL PROSTATE BIOPSY IS ASSOCIATED WITH GLEASON SCORE UPGRADING ON FINAL RADICAL PROSTATECTOMY PATHOLOY. Urol Oncol: Semin Orig Invest. 2024;42:S94. [DOI]