Baumgartner Erin M, Porter Kristin K, Nix Jeffrey W, Rais-Bahrami Soroush, Gordetsky Jennifer B
Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Transl Androl Urol. 2018 Sep;7(Suppl 4):S392-S396. doi: 10.21037/tau.2018.03.15.
Finding incidental extraprostatic extension (EPE) or seminal vesicle invasion (SVI) by prostate cancer (PCa) is rare on standard prostate biopsy. We evaluated the clinical-pathologic features associated with EPE and SVI on multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided targeted biopsy (TB).
A retrospective review was performed from 2014-2017, selecting patients who had undergone TB. Clinical, pathologic, and radiologic features were evaluated.
Five out of 333 (1.5%) patients who had PCa detected on TB had EPE and/or SVI. The average age and prostate-specific antigen (PSA) was 71 years and 17 ng/mL, respectively. The average number of cores taken on TB was 4.2. Two patients had a prior negative SB and two patients had a prior positive SB, one of which underwent radiation therapy. All patients had a PIRADSv2 suspicion score of 4 or 5. Four out of five (80%) patients underwent both SB and concurrent TB, of which 3/4 (75%) had EPE identified only on TB. One out of four (25%) patients also had both EPE and SVI, identified only on TB. One patient underwent only TB for MRI suspicion of SVI, which was pathologically confirmed on TB. On TB, one patient had Grade Group 3, two patients had Grade Group 4, and two patients had Grade Group 5 PCa. Perineural invasion (PNI) was present in 4/5 (80%) patients on TB.
Based on our small series, we hypothesize that MRI/US fusion TB outperforms SB in the identification of EPE and SVI. However, given the small sample size and the overall rarity of these pathologic findings on prostate biopsy, further validation is needed.
在标准前列腺活检中，偶然发现前列腺癌（PCa）伴有前列腺外扩展（EPE）或精囊侵犯（SVI）的情况很少见。我们评估了多参数磁共振成像（MRI）/超声（US）融合引导下靶向活检（TB）中与EPE和SVI相关的临床病理特征。
对2014年至2017年期间接受TB的患者进行回顾性研究。评估临床、病理和放射学特征。
在333例经TB检测出PCa的患者中，有5例（1.5%）出现EPE和/或SVI。患者的平均年龄和前列腺特异性抗原（PSA）分别为71岁和17 ng/mL。TB时平均取材条数为4.2条。2例患者之前系统活检（SB）结果为阴性，2例患者之前SB结果为阳性，其中1例接受过放射治疗。所有患者的前列腺影像报告和数据系统（PIRADS）v2可疑评分均为4或5分。5例患者中有4例（80%）同时接受了SB和同期TB，其中3/4（75%）仅在TB时发现EPE。4例患者中有1例（25%）在TB时同时发现EPE和SVI。1例患者因MRI怀疑SVI仅接受了TB，病理检查在TB时确诊。在TB时，1例患者为3级组，2例患者为4级组，2例患者为5级组PCa。5例患者中有4例（80%）在TB时存在神经周围侵犯（PNI）。
基于我们的小样本研究，我们推测MRI/US融合TB在识别EPE和SVI方面优于SB。然而，鉴于样本量小以及前列腺活检中这些病理发现总体罕见，需要进一步验证。
