Bartels, G.G. (2026) Het risico op een contralateraal klinisch significante prostaatkanker bij patiënten met unilateraal prostaatkanker op MRI Een retrospectieve cohortstudie naar de overeenkomst van preoperatieve biopsie- en MRI-stadiëring met de pathologie na prostatectomie. thesis, Medicine.
Full text available on request.Abstract
Background: Prostate cancer diagnosis utilizes multiparametric MRI (mpMRI) and biopsies. It remains debated whether targeted biopsies in unilateral MRI lesions should be combined with contralateral systematic biopsies, frequently leading to the overdiagnosis of clinically insignificant tumors. Objective: To determine the prevalence of contralateral tumors in patients with unilateral MRI lesions, with the secondary objective of evaluating agreement between preoperative MRI staging and definitive pathology. Methods: This retrospective cohort study (n=217) analyzed patients who underwent radical prostatectomy within Ziekenhuis Groep Twente (ZGT). Preoperative MRI findings and biopsies were compared with postoperative pathology as the reference standard. The prevalence of contralateral significant tumors (ISUP≥2) was calculated using 95% confidence intervals (95% CI). Agreement between MRI staging and pathology was determined using the weighted kappa coefficient. Results: Overall, contralateral tumors were pathologically identified in 20% of patients with a unilateral MRI lesion. Using the current standard of targeted and bilateral systematic biopsies, 4% (95% CI: 2%–7%) of clinically significant contralateral tumors (ISUP≥2) were missed. If contralateral biopsies were completely omitted and only targeted and ipsilateral biopsies were performed, 9% (95% CI: 6%–14%) of significant tumors would be missed. Agreement between MRI staging and pathology across the main clinical groups was fair, with a weighted kappa of 0.263 (95% CI: 0.140–0.386; p<0.001), where 35% of clinically T2-classified patients showed postoperative upstaging to ≥pT3. Conclusion: These results support considering a risk-stratified biopsy strategy in which contralateral biopsies can be omitted, provided ipsilateral and perilesional biopsies are preserved
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Beek, S. van and Bakker, D. |
| Faculty: | Medical Sciences |
| Date Deposited: | 30 Oct 2026 11:19 |
| Last Modified: | 30 Oct 2026 11:19 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3990 |
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