Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, New York; Urology Service, Fundacion Arturo Lopez Perez, Santiago, Chile.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2016 Aug;196(2):374-81. doi: 10.1016/j.juro.2016.02.084. Epub 2016 Feb 23.
We determined whether multiparametric magnetic resonance imaging targeted biopsies may replace systematic biopsies to detect higher grade prostate cancer (Gleason score 7 or greater) and whether biopsy may be avoided based on multiparametric magnetic resonance imaging among men with Gleason 3+3 prostate cancer on active surveillance.
We identified men with previously diagnosed Gleason score 3+3 prostate cancer on active surveillance who underwent multiparametric magnetic resonance imaging and a followup prostate biopsy. Suspicion for higher grade cancer was scored on a standardized 5-point scale. All patients underwent a systematic biopsy. Patients with multiparametric magnetic resonance imaging regions of interest also underwent magnetic resonance imaging targeted biopsy. The detection rate of higher grade cancer was estimated for different multiparametric magnetic resonance imaging scores with the 3 biopsy strategies of systematic, magnetic resonance imaging targeted and combined.
Of 206 consecutive men on active surveillance 135 (66%) had a multiparametric magnetic resonance imaging region of interest. Overall, higher grade cancer was detected in 72 (35%) men. A higher multiparametric magnetic resonance imaging score was associated with an increased probability of detecting higher grade cancer (Wilcoxon-type trend test p <0.0001). Magnetic resonance imaging targeted biopsy detected higher grade cancer in 23% of men. Magnetic resonance imaging targeted biopsy alone missed higher grade cancers in 17%, 12% and 10% of patients with multiparametric magnetic resonance imaging scores of 3, 4 and 5, respectively.
Magnetic resonance imaging targeted biopsies increased the detection of higher grade cancer among men on active surveillance compared to systematic biopsy alone. However, a clinically relevant proportion of higher grade cancer was detected using only systematic biopsy. Despite the improved detection of disease progression using magnetic resonance imaging targeted biopsy, systematic biopsy cannot be excluded as part of surveillance for men with low risk prostate cancer.
我们旨在确定多参数磁共振成像靶向活检是否可以替代系统活检来检测高级别前列腺癌（Gleason 评分 7 或更高），以及对于在主动监测中诊断为 Gleason 评分 3+3 前列腺癌的男性，是否可以基于多参数磁共振成像避免进行活检。
我们确定了先前在主动监测中诊断为 Gleason 评分 3+3 前列腺癌且接受多参数磁共振成像和后续前列腺活检的男性。使用标准化的 5 分制对高级别癌症的可疑程度进行评分。所有患者均接受系统活检。多参数磁共振成像感兴趣区域的患者还接受磁共振成像靶向活检。使用系统活检、磁共振成像靶向活检和联合活检这 3 种活检策略，估计不同多参数磁共振成像评分的高级别癌症的检出率。
在 206 例连续接受主动监测的男性中，有 135 例（66%）有磁共振成像感兴趣区域。总体而言，72 例（35%）男性检出高级别癌症。较高的多参数磁共振成像评分与更高的检出高级别癌症的概率相关（Wilcoxon 型趋势检验，p<0.0001）。磁共振成像靶向活检在 23%的男性中检出高级别癌症。单独进行磁共振成像靶向活检会遗漏 17%、12%和 10%多参数磁共振成像评分为 3、4 和 5 的患者中的高级别癌症。
与单独进行系统活检相比，磁共振成像靶向活检可增加主动监测男性中高级别癌症的检出率。然而，仅通过系统活检就可以检测到相当一部分高级别癌症。尽管磁共振成像靶向活检可以提高对疾病进展的检测，但在对低危前列腺癌患者进行监测时，不能排除系统活检。
