Porpiglia Francesco, DE Luca Stefano, Passera Roberto, Manfredi Matteo, Mele Fabrizio, Bollito Enrico, DE Pascale Agostino, Cossu Marco, Aimar Roberta, Veltri Andrea
Division of Urology, San Luigi Gonzaga Hospital Orbassano and University of Torino-I, Turin, Italy.
Division of Nuclear Medicine, San Giovanni Battista Hospital Torino and University of Torino-I, Turin, Italy
Anticancer Res. 2016 Sep;36(9):4833-9. doi: 10.21873/anticanres.11045.
To investigate if targeted prostate biopsy (TBx) has superior performance to standard untargeted biopsy (SBx) in determining the optimal agreement between biopsy and surgical Gleason Score (GS).
An analysis of our institutional longitudinal database identified 683 consecutive patients who underwent either SBx (18-20 standardized transrectal ultrasound peripheral/transitional zone cores) or TBx alone (4-6 cores for each multiparametric magnetic resonance suspicious lesion, Prostate Imaging Reporting and Data System [(PI-RADS)≥3] after a previous negative first SBx. A total of 246 consecutive patients with diagnosis of prostate cancer (117 SBx and 129 TBx diagnoses) who underwent robot-assisted radical prostatectomy between January 2014 and December 2015, were enrolled. The concordance of biopsy GS to pathological GS, as well as the association between categorical variables [age, digital rectal exam (DRE), TNM, PI-RADS], were analyzed by Fisher's exact test.
Prostate cancer was diagnosed in 32.0% of the SBx group and in 49.3% of TBx. The rate of correctly classified, up-graded and down-graded GS was 53.8% vs. 91.5%, 39.3% vs. 7.8% and 6.8% vs. 0.8% for SBx and TBx, respectively (p<0.001). The GS concordance rates for SBx and TBx cohorts were: 14.3% vs. 41.7% for GS 6, 61.0% vs. 83.8% for GS 3+4, 56.3% vs. 75.0% for GS 4+3, 27.3% vs. 100% for GS 8 and 80% vs. 100% for GS 9, respectively.
TBx ensured a higher of accuracy of prostate cancer detection and a better performance in discriminating significant from insignificant prostate cancer, when compared to SBx. TBx significantly reduced the risk of GS up-/down-grading at radical prostatectomy for all histopathological categories. This is a notable advance in the selection of candidates for active surveillance.
研究在确定活检与手术Gleason评分（GS）之间的最佳一致性方面，靶向前列腺活检（TBx）是否比标准非靶向活检（SBx）具有更优的性能。
对我们机构的纵向数据库进行分析，确定了683例连续患者，这些患者要么接受了SBx（18 - 20个标准化经直肠超声外周/移行区活检组织），要么仅接受了TBx（针对每个多参数磁共振可疑病变取4 - 6个活检组织，先前首次SBx为阴性后，前列腺影像报告和数据系统[(PI-RADS)≥3]）。共有246例在2014年1月至2015年12月期间接受机器人辅助根治性前列腺切除术且诊断为前列腺癌的连续患者（117例SBx诊断和129例TBx诊断）被纳入研究。通过Fisher精确检验分析活检GS与病理GS的一致性，以及分类变量[年龄、直肠指检（DRE）、TNM、PI-RADS]之间的关联。
SBx组中32.0%诊断为前列腺癌，TBx组中49.3%诊断为前列腺癌。SBx和TBx正确分类、升级和降级GS的比例分别为53.8%对91.5%、39.3%对7.8%和6.8%对0.8%（p<0.001）。SBx和TBx队列的GS一致性率分别为：GS 6时为14.3%对41.7%，GS 3 + 4时为61.0%对83.8%，GS 4 + 3时为56.3%对75.0%，GS 8时为27.3%对100%，GS 9时为80%对100%。
与SBx相比，TBx确保了更高的前列腺癌检测准确性，并且在区分有意义和无意义的前列腺癌方面表现更优。TBx显著降低了所有组织病理学类别的根治性前列腺切除术中GS升级/降级的风险。这是在选择主动监测候选者方面的一项显著进展。
