Borkowetz Angelika, Hadaschik Boris, Platzek Ivan, Toma Marieta, Torsev Georgi, Renner Theresa, Herout Roman, Baunacke Martin, Laniado Michael, Baretton Gustavo, Radtke Jan Philipp, Kesch Claudia, Hohenfellner Markus, Froehner Michael, Schlemmer Heinz-Peter, Wirth Manfred, Zastrow Stefan
Department of Urology, Technische Universität Dresden, Dresden, Germany.
Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
BJU Int. 2018 Jan;121(1):53-60. doi: 10.1111/bju.14017. Epub 2017 Oct 15.
To evaluate the value of multiparametric magnetic resonance imaging (mpMRI) in the detection of significant prostate cancer (PCa) and to compare transperineal MRI/ultrasonography fusion biopsy (fusPbx) with conventional transrectal systematic biopsy (sysPbx) in biopsy-naïve patients.
This multicentre, prospective trial investigated biopsy-naïve patients with suspicion of PCa undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PCa, defined as Gleason pattern 4 or 5. We analysed the results after a study period of 2 years.
The study included 214 patients. The median (range) number of targeted and systematic cores was 6 (2-15) and 12 (6-18), respectively. The overall PCa detection rate of comPbx was 52%. FusPbx detected more PCa than sysPbx (47% vs 43%; P = 0.15). The detection rate of significant PCa was 38% for fusPbx and 35% for sysPbx (P = 0.296). The rate of missed significant PCa was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PCa than fusPbx and sysPbx alone (44% vs 38% vs 35%; P < 0.005). In patients presenting with Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions there was a higher detection rate of significant PCa than in patients presenting with PI-RADS ≤3 lesions in comPbx (61% vs 14%; P < 0.005).
For biopsy-naïve men with tumour-suspicious lesions in mpMRI, the combined approach outperformed both fusPbx and sysPbx in the detection of overall PCa and significant PCa. Thus, biopsy-naïve patients may benefit from sysPbx in combination with mpMRI targeted fusPbx.
评估多参数磁共振成像（mpMRI）在检测显著前列腺癌（PCa）中的价值，并比较经会阴MRI/超声融合活检（fusPbx）与传统经直肠系统活检（sysPbx）在未接受过活检患者中的应用效果。
这项多中心前瞻性试验研究了未接受过活检且怀疑患有PCa的患者，这些患者接受了经会阴fusPbx联合经直肠sysPbx（联合活检，comPbx）。主要结局是检测出显著PCa，定义为Gleason分级模式4或5。我们在2年的研究期后分析了结果。
该研究纳入了214例患者。靶向活检和系统活检的中位（范围）芯数分别为6（2 - 15）和12（6 - 18）。联合活检的总体PCa检测率为52%。FusPbx检测出的PCa比sysPbx更多（47%对43%；P = 0.15）。FusPbx检测显著PCa的比率为38%，sysPbx为35%（P = 0.296）。FusPbx中漏诊显著PCa的比率为14%，sysPbx为21%。联合活检检测出的显著PCa明显多于单独的fusPbx和sysPbx（44%对38%对35%；P < 0.005）。在前列腺影像报告和数据系统（PI-RADS）4级和5级病变的患者中，联合活检检测显著PCa的比率高于PI-RADS≤3级病变的患者（61%对14%；P < 0.005）。
对于mpMRI中有肿瘤可疑病变的未接受过活检的男性，联合活检方法在检测总体PCa和显著PCa方面优于fusPbx和sysPbx。因此，未接受过活检的患者可能受益于sysPbx联合mpMRI靶向fusPbx。
