Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
BJU Int. 2018 Nov;122(5):794-800. doi: 10.1111/bju.14248. Epub 2018 May 9.
To determine whether replacement of protocol-driven repeat prostate biopsy (PB) with multiparametric magnetic resonance imaging (mpMRI) ± repeat targeted prostate biopsy (TB) when evaluating men on active surveillance (AS) for low-volume, low- to intermediate-risk prostate cancer (PCa) altered the likelihood of or time to treatment, or reduced the number of repeat biopsies required to trigger treatment.
A total of 445 patients underwent AS in the period 2010-2016 at our institution, with a median (interquartile range [IQR]) follow-up of 2.4 (1.2-3.7) years. Up to 2014, patients followed a 'pre-2014' AS protocol, which incorporated PB, and subsequently, according to the 2014 National Institute for Health and Care Excellence (NICE) guidelines, patients followed a '2014-present' AS protocol that included mpMRI. We identified four groups of patients within the cohort: 'no mpMRI and no PB'; 'PB alone'; 'mpMRI ± TB'; and 'PB and mpMRI ± TB'. Kaplan-Meier plots and log-rank tests were used to compare groups.
Of 445 patients, 132 (30%) discontinued AS and underwent treatment intervention, with a median (IQR) time to treatment of 1.55 (0.71-2.4) years. The commonest trigger for treatment was PCa upgrading after mpMRI and TB (43/132 patients, 29%). No significant difference was observed in the time at which patients receiving a PB alone or receiving mpMRI ± TB discontinued AS to undergo treatment (median 1.9 vs 1.33 years; P = 0.747). Considering only those patients who underwent repeat biopsy, a greater proportion of patients receiving TB after mpMRI discontinued AS compared with those receiving PB alone (29/66 [44%] vs 32/87 [37%]; P = 0.003). On average, a single set of repeat biopsies was needed to trigger treatment regardless of whether this was a PB or TB.
Replacing a systematic PB with mpMRI ±TB as part of an AS protocol increased the likelihood of re-classifying patients on AS and identifying men with clinically significant disease requiring treatment. mpMRI ±TB as part of AS thereby represents a significant advance in the oncological safety of the AS protocol.
确定在对接受低容量、低-中危前列腺癌（PCa）主动监测（AS）的男性进行评估时，是否用多参数磁共振成像（mpMRI）±重复靶向前列腺活检（TB）替代方案驱动的重复前列腺活检（PB），会改变治疗的可能性或时间，或减少触发治疗所需的重复活检次数。
本研究共纳入 445 例 2010 年至 2016 年期间在我院接受 AS 的患者，中位（四分位距 [IQR]）随访时间为 2.4（1.2-3.7）年。直到 2014 年，患者遵循“2014 年前”AS 方案，包括 PB，随后，根据 2014 年国家卫生与保健卓越研究所（NICE）指南，患者遵循包括 mpMRI 的“2014 年及以后”AS 方案。我们在队列中确定了四组患者：“无 mpMRI 且无 PB”、“单独 PB”、“mpMRI ± TB”和“PB 和 mpMRI ± TB”。采用 Kaplan-Meier 图和对数秩检验比较各组。
在 445 例患者中，有 132 例（30%）停止 AS 并接受治疗干预，中位（IQR）治疗时间为 1.55（0.71-2.4）年。最常见的治疗触发因素是 mpMRI 和 TB 后 PCa 升级（43/132 例患者，29%）。单独接受 PB 或接受 mpMRI ± TB 的患者停止 AS 并接受治疗的时间（中位数分别为 1.9 年和 1.33 年；P=0.747）无显著差异。仅考虑接受重复活检的患者，接受 mpMRI 后 TB 的患者较单独接受 PB 的患者更有可能停止 AS（29/66 [44%] vs 32/87 [37%]；P=0.003）。无论重复活检是 PB 还是 TB，平均只需一组重复活检即可触发治疗。
在 AS 方案中，用 mpMRI ±TB 替代系统的 PB，增加了重新分类 AS 患者和识别需要治疗的有临床意义疾病男性的可能性。因此，mpMRI ±TB 作为 AS 的一部分，代表了 AS 方案在肿瘤安全性方面的重大进展。
