Department of Urology, Imperial College Healthcare NHS (National Health Service) Trust, London, United Kingdom.
Department of Urology, University College London NHS Foundation Trust and Imperial Prostate, London, United Kingdom.
J Urol. 2020 Jan;203(1):100-107. doi: 10.1097/JU.0000000000000455. Epub 2019 Jul 23.
We evaluated the performance of transrectal ultrasound guided systematic and transperineal template mapping biopsies with a 5 mm sampling frame stratified by the multiparametric magnetic resonance imaging Likert score in the PROMIS (Prostate MR Imaging Study).
Biopsy naïve men due to undergo prostate biopsy for elevated prostate specific antigen and/or abnormal digital rectal examination underwent multiparametric magnetic resonance imaging, and transperineal template mapping and transrectal ultrasound guided systematic biopsies, which were performed and reported while blinded to other test results. Clinically significant prostate cancer was primarily defined as Gleason 4 + 3 or greater, or a maximum cancer core length of 6 mm or more of any grade. It was secondarily defined as Gleason 3 + 4 or greater, or a maximum cancer core length of 4 mm or more of any grade.
In 41 months 740 men were recruited at a total of 11 centers, of whom 576 underwent all 3 tests. Eight of the 150 men (5.1%) with a multiparametric magnetic resonance imaging score of 1-2 had any Gleason 3 + 4 or greater disease on transrectal ultrasound guided systematic biopsy. Of the 75 men in whom transrectal ultrasound guided systematic biopsy showed Gleason 3 + 3 of any maximum cancer core length 61 (81%) had Gleason 3 + 4, 8 (11%) had Gleason 4 + 3 and 0 (0%) had Gleason 4 + 5 or greater disease. For definition 1 (clinically significant prostate cancer) transrectal ultrasound guided systematic biopsy sensitivity remained stable and low across multiparametric magnetic resonance imaging Likert scores of 35% to 52%. For definition 2 (clinically significant prostate cancer and any cancer) sensitivity increased with higher multiparametric magnetic resonance imaging scores. The negative predictive value varied due to varying disease prevalence but for all cancer thresholds it declined with increasing multiparametric magnetic resonance imaging scores.
In the setting of multiparametric magnetic resonance imaging Likert scores 1-2 transrectal ultrasound guided systematic biopsy revealed Gleason 3 + 4 disease in only 1 of 20 men. Further, for any clinically significant prostate cancer definition transrectal ultrasound guided systematic biopsy had poor sensitivity and variable but a low negative predictive value across multiparametric magnetic resonance imaging scores. Men who undergo transrectal ultrasound guided systematic biopsy without targeting in the setting of a multiparametric magnetic resonance imaging score of 3 to 5 should be advised to undergo repeat (targeted) biopsy.
我们评估了经直肠超声引导的系统活检和经会阴模板定位活检在多参数磁共振成像 Likert 评分分层下的表现，该评分用于 PROMIS（前列腺磁共振成像研究）。
因前列腺特异性抗原升高和/或直肠指检异常而接受前列腺活检的活检初治男性患者接受了多参数磁共振成像检查，并进行了经会阴模板定位活检和经直肠超声引导的系统活检，这些检查和报告都是在不了解其他检查结果的情况下进行的。临床显著前列腺癌主要定义为 Gleason 评分 4+3 或更高，或任何分级的最大癌核长度 6mm 或更长；次要定义为 Gleason 评分 3+4 或更高，或任何分级的最大癌核长度 4mm 或更长。
在 41 个月的时间里，11 个中心共招募了 740 名男性患者，其中 576 名男性患者接受了所有 3 项检查。在多参数磁共振成像评分 1-2 的 150 名男性患者中，有 8 名（5.1%）在经直肠超声引导的系统活检中发现任何 Gleason 3+4 或更高分级的疾病。在经直肠超声引导的系统活检显示最大癌核长度 6mm 的 Gleason 3+3 的 75 名男性患者中，61 名（81%）有 Gleason 3+4，8 名（11%）有 Gleason 4+3，0 名（0%）有 Gleason 4+5 或更高分级的疾病。对于定义 1（临床显著前列腺癌），在多参数磁共振成像 Likert 评分 35%至 52%的范围内，经直肠超声引导的系统活检的敏感性保持稳定且较低。对于定义 2（临床显著前列腺癌和任何癌症），敏感性随多参数磁共振成像评分的升高而增加。阴性预测值因疾病患病率的不同而不同，但对于所有癌症阈值，随着多参数磁共振成像评分的升高而降低。
在多参数磁共振成像 Likert 评分 1-2 的情况下，经直肠超声引导的系统活检仅在 20 名男性中的 1 名中发现 Gleason 3+4 疾病。此外，对于任何临床显著前列腺癌定义，经直肠超声引导的系统活检的敏感性均较差，且在多参数磁共振成像评分范围内的阴性预测值也各不相同，但均较低。在多参数磁共振成像评分 3 至 5 的情况下，未针对多参数磁共振成像评分进行靶向活检而接受经直肠超声引导的系统活检的男性，应告知他们接受重复（靶向）活检。
