Borkowetz Angelika, Renner Theresa, Platzek Ivan, Toma Marieta, Herout Roman, Baunacke Martin, Groeben Christer, Huber Johannes, Laniado Michael, Baretton Gustavo B, Froehner Michael, Zastrow Stefan, Wirth Manfred P
Department of Urology, Technische Universität Dresden, Dresden, Germany.
Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany.
Urol Int. 2018;100(2):155-163. doi: 10.1159/000486041. Epub 2018 Jan 16.
Targeted biopsy of tumour-suspicious lesions detected in multiparametric magnetic resonance imaging (mpMRI) plays an increasing role in the active surveillance (AS) of patients with low-risk prostate cancer (PCa). The aim of this study was to compare MRI/ultrasound-fusion biopsy (fusPbx) with systematic biopsy (sysPbx) in patients undergoing biopsy for AS.
Patients undergoing mpMRI and transperineal fusPbx combined with transrectal sysPbx (comPbx) as surveillance biopsy were investigated. The detection of Gleason score upgrading and reclassification according to Prostate Cancer Research International Active Surveillance criteria were evaluated.
Eighty-three patients were enrolled. PCa upgrading was detected in 39% by fusPbx and in 37% by sysPbx (p = 1.0). The percentage of patients who were reclassified in fusPbx and sysPbx (p = 0.45) were 64 and 59% respectively. ComPbx detected more frequently tumour upgrading than fusPbx (71 vs. 64%, p = 0.016) and sysPbx (71 vs. 59%, p < 0.001) and more patients had to be reclassified after comPbx than after fusPbx or sysPbx alone.
The combination of fusPbx and sysPbx outperforms both modalities alone with regard to the detection of upgrading and reclassification in patients under AS. Because a high missing rate of significant PCa still exists in both biopsy modalities, a combination of fusPbx and sysPbx should be recommended in these patients.
在多参数磁共振成像（mpMRI）中检测到的可疑肿瘤病变的靶向活检在低风险前列腺癌（PCa）患者的主动监测（AS）中发挥着越来越重要的作用。本研究的目的是比较MRI/超声融合活检（fusPbx）与系统活检（sysPbx）在接受AS活检的患者中的情况。
对接受mpMRI和经会阴fusPbx联合经直肠sysPbx（comPbx）作为监测活检的患者进行研究。评估根据国际前列腺癌研究主动监测标准的Gleason评分升级和重新分类的检测情况。
纳入83例患者。fusPbx检测到39%的患者PCa升级，sysPbx检测到37%的患者PCa升级（p = 1.0）。fusPbx和sysPbx中重新分类的患者百分比分别为64%和59%（p = 0.45）。ComPbx比fusPbx（71%对64%，p = 0.016）和sysPbx（71%对59%，p < 0.001）更频繁地检测到肿瘤升级，并且comPbx后需要重新分类的患者比单独的fusPbx或sysPbx后更多。
在AS患者的升级和重新分类检测方面，fusPbx和sysPbx的联合使用比单独使用两种方法都更具优势。由于两种活检方法中仍存在显著PCa的高漏诊率，因此建议在这些患者中使用fusPbx和sysPbx的联合方法。
