Connor Martin J, Miah Saiful, Jayadevan Rajiv, Khoo Christopher C, Eldred-Evans David, Shah Taimur, Ahmed Hashim U, Marks Leonard
Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.
Department of Urology, Cambridge University Hospitals, Hills Road, Cambridge, U.K.
Transl Androl Urol. 2020 Jun;9(3):1501-1509. doi: 10.21037/tau.2019.07.16.
The clinical utility of systematic prostate biopsy in addition to multi-parametric magnetic resonance imagining (mp-MRI) targeted biopsy pathways remains unclear. Despite radiological advancements in mp-MRI and utilisation of international standardised reporting systems (i.e., PI-RADS, LIKERT), undetected clinically significant prostate cancer (csPCa) on imaging persists. This has prevented the widespread adoption of an exclusively targeted biopsy approach. The current evidence on csPCa cancer detection rates in mp-MRI targeted alone and combined with a non-targeted systematic sampling is presented. Arguments for and against routine limited systematic sampling as an adjunct to an mp-MRI targeted biopsy are discussed. Our review will report the clinical utility of a combined sampling strategy on csPCa detection rate. The available evidence suggests that we are yet to reach a stage where non-targeted systematic prostate biopsy can be routinely omitted in mp-MRI targeted prostate biopsy pathways. Research should focus on improving the accuracy of mp-MRI, prostate biopsy techniques, and in identifying those men that will most benefit from a combined prostate biopsy. Such strategies may help future urologists reduce the burden of non-targeted cores in modern mp-MRI prostate biopsy pathways.
除多参数磁共振成像（mp-MRI）靶向活检途径外，系统性前列腺活检的临床效用仍不明确。尽管mp-MRI在放射学方面取得了进展，且采用了国际标准化报告系统（即PI-RADS、李克特量表），但影像学上仍存在未检测到的临床显著前列腺癌（csPCa）。这阻碍了仅采用靶向活检方法的广泛应用。本文介绍了目前关于单独mp-MRI靶向活检以及与非靶向系统性采样相结合时csPCa癌症检出率的证据。讨论了支持和反对将常规有限系统性采样作为mp-MRI靶向活检辅助手段的观点。我们的综述将报告联合采样策略对csPCa检出率的临床效用。现有证据表明，我们尚未达到在mp-MRI靶向前列腺活检途径中可以常规省略非靶向系统性前列腺活检的阶段。研究应聚焦于提高mp-MRI的准确性、前列腺活检技术，以及识别那些将从联合前列腺活检中获益最大的男性。此类策略可能有助于未来的泌尿外科医生减轻现代mp-MRI前列腺活检途径中非靶向活检组织的负担。
