Reply to Editorial Comment: Grade Group 1 Core Volume at Time of Biopsy Is Not Associated With Rate of Adverse Pathology at Radical Prostatectomy

We would like to thank Drs Abedi and Petros1 for their thoughtful editorial on our paper.2 We agree with their points, particularly that the use of modified National Comprehensive Cancer Network (NCCN) criteria may result in de-escalation of radical treatment for those who are reclassified as favorable intermediate-risk disease and the fact that external validation of our findings is needed. Furthermore, although we agree that use of MRI-visible biopsy core volume is limited in that it does not include systematic core results, we put forth that this is a potential benefit of this prognostic approach. Increasing evidence suggests that MRI-visible disease is associated with an increased risk of unfavorable outcomes when compared with invisible disease.3,4 Furthermore, this factor would allow for risk stratification when using targeted-only biopsies, which may limit the detection of clinically insignificant disease.5 We are therefore hopeful that future studies will elucidate improved prognostic systems that will help inform guideline-based risk stratification systems among men with intermediate-risk prostate cancer.