Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
BJU Int. 2018 Jun;121(6):863-870. doi: 10.1111/bju.14100. Epub 2018 Jan 17.
To assess the accuracy and utility of routine multiparametric magnetic resonance imaging (mpMRI) and transperineal template-guided prostate biopsy (TPB) after enrolment in active surveillance (AS).
From April 2012 to December 2016 consecutive men from our single institution, diagnosed with low- or intermediate-risk prostate cancer on transrectal ultrasonography-guided biopsy, were offered further staging with early mpMRI and TPB within 12 months of diagnosis. Data were collected prospectively. Eligibility criteria comprised: age ≤77 years; Gleason score ≤3 + 4; clinical stage T1-T2; PSA ≤15 ng/mL; and <50% positive biopsy cores.
A total of 208 men were enrolled, including 196 with Gleason score 3 + 3 and 12 with Gleason score 3 + 4 disease. The median (range) number of TPB cores was 50 (17-161), with a mean TPB core density of 1.2 cores/cm prostate volume. A total of 83 men (39.9%) underwent histopathological upgrading after TPB, including 76 men (38.8%) with Gleason score 3 + 3 disease and seven men (58.3%) with Gleason score 3 + 4 disease. Of these, 26 (31.3%) were found to harbour primary pattern Gleason grade ≥4 disease. In all, 24 (28.9%) upgraded cases had Prostate Imaging Reporting and Data System (PI-RADS) score 1 or 2 lesions on mpMRI, including five men with Gleason score ≥4 + 3 disease. Of these, 14 (58.3%) had a prostate-specific antigen (PSA) density of ≥0.15, including four out of the five men with Gleason ≥4 + 3 disease. Overall there was a change in prostate cancer management in 77 men (37.0%) after TPB.
Early TPB during AS is associated with significant upgrading and a change in treatment plan in over a third of men. If TPB was omitted in men with a PI-RADS score <3 and a PSA density <0.15, 12% of those harbouring more significant disease would have been misclassified.
评估主动监测（AS）入组后常规多参数磁共振成像（mpMRI）和经会阴模板引导前列腺活检（TPB）的准确性和实用性。
2012 年 4 月至 2016 年 12 月，我们单中心连续收治经直肠超声引导活检诊断为低危或中危前列腺癌的患者，入组后 12 个月内行早期 mpMRI 和 TPB 进一步分期。前瞻性收集数据。入选标准包括：年龄≤77 岁；Gleason 评分≤3+4；临床分期 T1-T2；PSA≤15ng/mL；和<50%阳性活检核心。
共纳入 208 例患者，其中 Gleason 评分 3+3 者 196 例，Gleason 评分 3+4 者 12 例。TPB 核心的中位数（范围）为 50（17-161），平均 TPB 核心密度为 1.2 个核心/cm 前列腺体积。TPB 后共有 83 例（39.9%）发生组织病理学升级，其中 Gleason 评分 3+3 者 76 例（38.8%），Gleason 评分 3+4 者 7 例（58.3%）。其中 26 例（31.3%）为原发性模式 Gleason 分级≥4 疾病。共有 24 例（28.9%）升级病例在 mpMRI 上存在前列腺影像报告和数据系统（PI-RADS）评分 1 或 2 病变，其中 Gleason 评分≥4+3 疾病 5 例。这些患者中，PSA 密度≥0.15 的有 14 例（58.3%），其中 Gleason 评分≥4+3 疾病 4 例。总的来说，TPB 后 77 例（37.0%）患者的前列腺癌管理发生了变化。
AS 期间早期 TPB 与超过三分之一男性的显著升级和治疗计划改变相关。如果在 PI-RADS 评分<3 和 PSA 密度<0.15 的男性中省略 TPB，则 12%的隐匿性疾病可能会被误诊。
