Bass Edward J, Orczyk Clement, Grey Alistair, Freeman Alex, Jameson Charles, Punwani Shonit, Ramachandran Navin, Allen Clare, Emberton Mark, Ahmed Hashim U
Division of Surgery and Interventional Science, University College London, London, UK.
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
BJU Int. 2019 Oct;124(4):643-648. doi: 10.1111/bju.14806. Epub 2019 Jun 2.
To investigate whether patients with Gleason 3 + 4 cancer on transrectal biopsy are upgraded after undergoing transperineal magnetic resonance imaging (MRI)-targeted biopsy and whether this has implications for current clinical practice.
In this retrospective analysis we examined 107 consecutive patients presenting at a single tertiary referral centre (July 2012 to July 2016) with prostate cancer of Gleason score 3 + 4 on transrectal ultrasonography (TRUS)-guided systematic non-targeted biopsy who then underwent a multiparametric MRI followed by MRI-targeted transperineal prostate biopsy for accurate risk stratification and localization.
The patients' mean (sd) age was 67.0 (8.0) years, and they had a median (interquartile range) PSA concentration of 6.2 (4.7-9.6) ng/mL. Of the 107 patients, 84 (78.5%) had Gleason 3 + 4 on both transrectal systematic biopsy and transperineal MRI-targeted biopsy. Nineteen patients (17.8%) were upgraded to Gleason 4 + 3, three patients (3.0%) to Gleason 4 + 4 and one patient (1.0%) to Gleason 4 + 5. These differences were significant (P = 0.0006). Likewise, 23/107 patients (22%) had higher-risk disease based on their targeted biopsies.
The use of targeted biopsy in men with impalpable cancer, ultimately upgraded one in five patients from favourable-intermediate- to unfavourable-intermediate-risk disease or worse. This has significant clinical implications for men considering active surveillance or radical treatment. Our risk calculators must now be validated using these data from targeted biopsy as the technique becomes widely adopted.
探讨经直肠活检显示为Gleason 3+4癌的患者在接受经会阴磁共振成像（MRI）靶向活检后是否会升级，以及这对当前临床实践是否有影响。
在这项回顾性分析中，我们检查了在一家三级转诊中心（2012年7月至2016年7月）连续就诊的107例患者，这些患者经直肠超声（TRUS）引导下的系统非靶向活检显示为Gleason评分3+4的前列腺癌，随后接受多参数MRI检查，然后进行MRI靶向经会阴前列腺活检，以进行准确的风险分层和定位。
患者的平均（标准差）年龄为67.0（8.0）岁，前列腺特异性抗原（PSA）浓度中位数（四分位间距）为6.2（4.7-9.6）ng/mL。在107例患者中，84例（78.5%）经直肠系统活检和经会阴MRI靶向活检均为Gleason 3+4。19例患者（17.8%）升级为Gleason 4+3，3例患者（3.0%）升级为Gleason 4+4，1例患者（1.0%）升级为Gleason 4+5。这些差异具有统计学意义（P=0.0006）。同样，23/107例患者（22%）基于靶向活检患有更高风险的疾病。
对于无法触及的癌症患者使用靶向活检，最终将五分之一的患者从有利-中等风险疾病升级为不利-中等风险疾病或更差。这对于考虑积极监测或根治性治疗的男性具有重要的临床意义。随着该技术被广泛采用，我们的风险计算器现在必须使用来自靶向活检的数据进行验证。
