Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
J Urol. 2018 Nov;200(5):1035-1040. doi: 10.1016/j.juro.2018.06.026. Epub 2018 Jun 20.
Based on findings in transrectal ultrasound guided biopsy series standard sampling of the prostate targets the posterior/peripheral zone. However, a substantial proportion of lesions that are prostate cancer suspicious and PI-RADS™ (Prostate Imaging Reporting and Data System) 3 or greater on magnetic resonance imaging is located in the anterior segment of the prostate, requiring deeper placement and targeting of the biopsy needle.
Overall 1,161 patients underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy. Prostate cancer suspicious lesions on magnetic resonance imaging were dichotomized into anterior vs posterior prostate segments. Patients were stratified by the number of prior negative systematic biopsy sessions. Descriptive statistics included the frequency and proportion of multiparametric magnetic resonance imaging findings and corresponding histological results.
Targeted biopsy was performed in 513 patients (44%) who were systematic biopsy naïve, 396 (34%) with 1 prior negative systematic biopsy and 252 (22%) with 2 or more prior negative systematic biopsies. When patients were stratified by the number of prior systematic biopsy sessions, the proportion with exclusively anterior, PI-RADS 3 or greater lesions on magnetic resonance imaging increased from 3.5% to 9.1% (p = 0.006). Unfavorable 3 + 4 and 4 + 3 or greater primary Gleason patterns were identified in exclusively anterior vs posterior lesions in 31% vs 21% of the 448 patients, of whom 64 had exclusively anterior and 384 had posterior PI-RADS 3 or greater lesions, respectively, on magnetic resonance imaging. Multivariable logistic regression analyses confirmed these findings.
After multiple previous negative systematic biopsy sessions the proportion of anterior lesions on magnetic resonance imaging increased. Such lesions harbored a greater amount of unfavorable prostate cancer. Therefore, image guidance for precise targeting should be considered, especially after initially negative transrectal ultrasound guided systematic biopsy.
基于经直肠超声引导活检系列研究的结果，前列腺标准取样靶向于后/外周区。然而，相当一部分前列腺癌可疑病变和磁共振成像上的 PI-RADS™（前列腺影像报告和数据系统）3 级或更高的病变位于前列腺的前叶，需要更深地放置和靶向活检针。
共有 1161 例患者接受了磁共振成像/超声融合引导靶向活检。磁共振成像上的前列腺癌可疑病变分为前叶和后叶前列腺段。患者按先前阴性系统活检次数分层。描述性统计包括多参数磁共振成像发现和相应组织学结果的频率和比例。
在 513 例（44%）初次行系统活检的患者中进行了靶向活检，396 例（34%）患者有 1 次阴性系统活检，252 例（22%）患者有 2 次或以上阴性系统活检。当患者按先前系统活检次数分层时，磁共振成像上仅表现为前叶、PI-RADS 3 级或更高病变的患者比例从 3.5%增加到 9.1%（p = 0.006）。在 448 例仅表现为前叶或后叶 PI-RADS 3 级或更高病变的患者中，31%的患者中仅前叶病变有不利的 3+4 和 4+3 或更高的主要 Gleason 模式，21%的患者中后叶病变有不利的 3+4 和 4+3 或更高的主要 Gleason 模式，其中 64 例患者仅表现为前叶病变，384 例患者仅表现为后叶 PI-RADS 3 级或更高病变。多变量逻辑回归分析证实了这些发现。
在前几次阴性系统活检后，磁共振成像上前叶病变的比例增加。这些病变含有更多的不利前列腺癌。因此，应考虑进行图像引导以进行精确靶向，特别是在最初经直肠超声引导系统活检阴性后。
