Pepe Pietro, Cimino Sebastiano, Garufi Antonio, Priolo Giandomenico, Russo Giorgio Ivan, Giardina Raimondo, Reale Giulio, Barbera Michele, Panella Paolo, Pennisi Michele, Morgia Giuseppe
Urology Unit, Cannizzaro Hospital, Catania.
Arch Ital Urol Androl. 2016 Dec 30;88(4):300-303. doi: 10.4081/aiua.2016.4.300.
The detection rate for significant prostate cancer of extended vs saturation vs mMRI/TRUS fusion biopsy was prospectively evaluated in men enrolled in active surveillance (AS) protocol. Mterials and methods: From May 2013 to September 2016 75 men aged 66 years (median) with very low risk PCa were enrolled in an AS protocol and elegible criteria were: life expectancy greater than 10 years, cT1C, PSA below 10 ng/ml, PSA density < 0.20, 2 < unilateral positive biopsy cores, Gleason score (GS) equal to 6, greatest percentage of cancer (GPC) in a core < 50%. All patients underwent 3.0 Tesla pelvic mpMRI before confirmatory transperineal extended (20 cores) or saturation biopsy (SPBx; 30 cores) combined with mpMRI/TRUS fusion targeted biopsy (4 cores) of suspicious lesions (PI-RADS 3-5).
21/75 (28%) patients were reclassified by SPBx based on upgraded GS ≥ 7; mpMRI lesions PI-RADS 4-5 vs PI-RADS 3-5 diagnosed 9/21 (42.8%) vs 16/21 (76.2%) significant PCa with 2 false positives (6.5%). The detection rate for significant PCa was equal to 76.2% (mpMRI/TRUS fusion biopsy) vs 81% (extended) vs 100% (SPBx) (p = 0.001); mpMRI/TRUS targeted biopsy and extended biopsy missed 5/21 (23.8%) and 4/21 (19%) significant PCa which were found by SPBx (p = 0.001) being characterised by the presence of a single positive core of GS ≥ 7 with GPC < 10%.
Although mpMRI improve the diagnosis of clinically significant PCa, SPBx is provided of the best detection rate for PCa in men enrolled in AS protocols who underwent confirmatory biopsy.
在参加主动监测（AS）方案的男性中，前瞻性评估了扩展活检、饱和活检与磁共振成像/经直肠超声（mMRI/TRUS）融合活检对显著前列腺癌的检出率。材料与方法：2013年5月至2016年9月，75名年龄（中位数）为66岁的极低风险前列腺癌男性参加了AS方案，入选标准为：预期寿命大于10年，cT1C，前列腺特异性抗原（PSA）低于10 ng/ml，PSA密度<0.20，单侧阳性活检芯数<2个，Gleason评分（GS）等于6，芯内最大癌灶百分比（GPC）<50%。所有患者在进行经会阴扩展活检（20个芯）或饱和活检（SPBx；30个芯）并结合对可疑病变（前列腺影像报告和数据系统[PI-RADS] 3 - 5类）进行mMRI/TRUS融合靶向活检（4个芯）之前，均接受了3.0特斯拉盆腔磁共振成像检查。
21/75（28%）的患者经SPBx检查后因GS≥7升级而重新分类；PI-RADS 4 - 5类与PI-RADS 3 - 5类的mMRI病变分别诊断出9/21（42.8%）与16/21（76.2%）的显著前列腺癌，有2例假阳性（6.5%）。显著前列腺癌的检出率分别为76.2%（mMRI/TRUS融合活检）、81%（扩展活检）和100%（SPBx）（p = 0.001）；mMRI/TRUS靶向活检和扩展活检分别漏诊了5/21（23.8%）和4/21（19%）经SPBx发现的显著前列腺癌（p = 0.001），这些漏诊病例的特征为存在一个GS≥7且GPC<10%的阳性芯。
尽管mMRI可改善临床显著前列腺癌的诊断，但对于参加AS方案并接受确诊活检的男性，SPBx对前列腺癌的检出率最高。
