Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur Urol Oncol. 2020 Feb;3(1):112-118. doi: 10.1016/j.euo.2019.03.002. Epub 2019 Mar 27.
Whether or not adding systematic biopsies (transrectal ultrasound-guided biopsy [TRUS-Bx]) to targeted cores in patients with a lesion detected at multiparametric magnetic resonance imaging (mpMRI) is still a debated topic.
To identify patients who can avoid TRUS-Bx at the time of mpMRI targeted biopsy (MRI-TBx) relying on individual patient probability to harbour clinically significant prostate cancer (csPCa) outside the index lesion (IL).
DESIGN, SETTING, AND PARTICIPANTS: A total of 339 European and 441 North American patients underwent fusion MRI-TBx and concomitant TRUS-Bx at two tertiary care referral centres between 2013 and 2017.
The study outcome was csPCa, defined as a Gleason score at biopsy of ≥7, outside the IL. Multivariable logistic regression analyses (MVAs) were performed to develop a predictive model for the study outcome. Multivariable-derived coefficients were used to develop a novel risk calculator in each cohort. The models were evaluated using the area under the curve (AUC), calibration plot, and decision-curve analyses.
In the European cohort, csPCa detection rate was 55%. The csPCa detection rate for TRUS-Bx was 41%. At MVAs, prostate volume, previous negative biopsy, and Prostate Imaging Reporting and Data System versions 4 and 5 were independent predictors for the presence of csPCa outside the IL. The multivariable model had an AUC of 0.78. Omitting TRUS-Bx in patients with a calculated risk of <15% would have spared 16% of TRUS-Bx at the cost of missing 7% of csPCa. Similar findings were obtained when the same analyses were performed in the North American cohort. No net benefit was observed for low-threshold probabilities (<15%) of the each model relative to the standard of care (performing TRUS-Bx in addition to MRI-TBx to all patients) in both cohorts. The study is limited by its retrospective design.
We failed to identify those patients who might safely benefit from MRI-TBx alone. The combination of MRI-TBx and TRUS-Bx should strongly be considered the best available approach.
In the presence of positive multiparametric magnetic resonance imaging (mpMRI) of the prostate, physicians should always perform systematic sampling of the prostate in addition to mpMRI targeted biopsy.
在多参数磁共振成像（mpMRI）检测到病变的患者中，是否在靶向核心部位增加系统活检（经直肠超声引导活检[TRUS-Bx]）仍然存在争议。
基于患者个体发生临床显著前列腺癌（csPCa）的概率，在 mpMRI 靶向活检（MRI-TBx）时确定可以避免对非目标病变（IL）部位进行 TRUS-Bx 的患者。
设计、地点和参与者：这项研究共纳入了 2013 年至 2017 年期间在两个三级转诊中心接受融合 MRI-TBx 和同时进行的 TRUS-Bx 的 339 名欧洲患者和 441 名北美患者。
研究结局为 csPCa，定义为 IL 外活检时的 Gleason 评分≥7。采用多变量逻辑回归分析（MVAs）来建立研究结局的预测模型。在每个队列中，使用多变量推导的系数来开发一种新的风险计算器。使用曲线下面积（AUC）、校准图和决策曲线分析来评估模型。
在欧洲队列中，csPCa 的检出率为 55%。TRUS-Bx 的 csPCa 检出率为 41%。MVAs 分析中，前列腺体积、既往阴性活检和前列腺成像报告和数据系统版本 4 和 5 是 IL 外存在 csPCa 的独立预测因素。多变量模型的 AUC 为 0.78。在计算风险<15%的患者中，省略 TRUS-Bx 可避免 16%的 TRUS-Bx 检查，但代价是漏诊 7%的 csPCa。当在北美队列中进行相同的分析时，也得到了类似的结果。对于每个模型的低阈值概率（<15%），与标准治疗（对所有患者进行 TRUS-Bx 加 MRI-TBx）相比，在两个队列中均未观察到净获益。本研究的局限性在于其回顾性设计。
我们未能确定那些可能从单独的 MRI-TBx 中安全获益的患者。MRI-TBx 联合 TRUS-Bx 应被强烈视为最佳治疗方法。
在前列腺多参数磁共振成像（mpMRI）阳性的情况下，医生应始终在 mpMRI 靶向活检的基础上，对前列腺进行系统取样。
