Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France.
Department of Urology, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France.
J Urol. 2019 Dec;202(6):1182-1187. doi: 10.1097/JU.0000000000000418. Epub 2019 Jun 27.
We assessed the added value of concomitant systematic biopsy for final grade group prediction in patients with positive magnetic resonance imaging who were undergoing targeted biopsy.
Included in study were 478 consecutive patients with prebiopsy positive multiparametric magnetic resonance imaging and a greater than 10-core systematic biopsy combined with fusion targeted biopsy who underwent radical prostatectomy. The primary end point was the grade group concordance between biopsy and radical prostatectomy pathology according to the biopsy technique. Clinical and biological factors associated with the performance of systematic biopsy were analyzed.
Adding systematic biopsy to targeted biopsy modified the d'Amico risk classification toward more intermediate and high risk in 7.8% of cases, mainly from low to intermediate risk with low risk prostate cancer on targeted biopsy in 44.3%. This reclassification was significantly higher in patients with lower prostate specific antigen and with prostate specific antigen density less than 0.20 ng/ml/gm (11.7% vs 2.4%, p <0.001). The concordance rate between biopsy pathology and radical prostatectomy pathology significantly differed between targeted biopsy and targeted biopsy plus systematic biopsy (45.2% and 51.7%, respectively). The upgrading rate in radical prostatectomy specimens decreased by 22% when systematic biopsy was added to targeted biopsy. Patients in whom systematic biopsy did not modify grading were more likely to have pT3-4 and/or pN1 disease on final pathology (56.9% vs 38.3%, p=0.007).
Grading concordance between biopsy pathology and radical prostatectomy pathology was improved by adding systematic biopsy in all patient subgroups. Patients with prostate specific antigen density less than 0.20 ng/ml/gm benefited the most from this combined biopsy strategy. Systematic biopsy reclassified a nonnegligible number of cases toward a higher risk category, mainly the low risk cases. Thus, systematic biopsy could modify treatment decision making.
我们评估了在接受靶向活检的磁共振成像阳性患者中，同时进行系统性活检对最终分级组预测的附加价值。
研究纳入了 478 例经术前多参数磁共振成像检查证实为阳性且进行了大于 10 芯系统活检联合融合靶向活检的连续患者，这些患者均接受了根治性前列腺切除术。主要终点是根据活检技术，活检和根治性前列腺切除术病理之间的分级组一致性。分析了与系统活检表现相关的临床和生物学因素。
在靶向活检的基础上增加系统活检，将 7.8%的病例的 d'Amico 风险分类向中高危方向改变，主要是将低危前列腺癌的病例从靶向活检的低危分类向中危分类改变，比例为 44.3%。在前列腺特异性抗原较低且前列腺特异性抗原密度小于 0.20ng/ml/gm 的患者中，这种重新分类的比例明显更高（11.7%比 2.4%，p<0.001）。靶向活检和靶向活检联合系统活检之间的活检病理与根治性前列腺切除术病理的一致性显著不同（分别为 45.2%和 51.7%）。当靶向活检联合系统活检时，根治性前列腺切除标本的升级率降低了 22%。在最终病理中没有改变分级的患者，更有可能出现 pT3-4 和/或 pN1 疾病（56.9%比 38.3%，p=0.007）。
在所有患者亚组中，增加系统活检可提高活检病理与根治性前列腺切除术病理的分级一致性。前列腺特异性抗原密度小于 0.20ng/ml/gm 的患者从这种联合活检策略中获益最大。系统活检将相当数量的病例重新分类为高危类别，主要是低危病例。因此，系统活检可以改变治疗决策。
