Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Università degli Studi di Milano, Milan, Italy.
Prostate Cancer Prostatic Dis. 2021 Jun;24(2):406-413. doi: 10.1038/s41391-020-00290-4. Epub 2020 Sep 28.
To test clinically significant prostate cancer (csPCa) rates during follow-up in biopsy naïve patients that underwent two different diagnostic pathways: (1) SB GROUP (n = 354): systematic random biopsies (SB) vs. (2) TB GROUP (n = 264): multiparametric magnetic resonance imaging (mpMRI) and only targeted biopsies (TB) of PI-RADS ≥ 3 lesions. Patients with PI-RADS ≤ 2 score avoided prostate biopsies.
Retrospective single centre study of 618 biopsy naive patients (2015-2018). Two different definitions of csPCa were used: (1) csPCa ISUP GG ≥ 2 (ISUP grade group [GG] ≥ 2) and (2) csPCa ISUP GG ≥ 3. Kaplan-Meier plots and univariable Cox regression models tested rates over time of csPCa ISUP GG ≥ 2 and caPCa ISUP GG ≥ 3 in SB GROUP vs. TB GROUP.
At initial biopsy, TB achieved higher rates of csPCa ISUP GG ≥ 2 (35.3 vs. 18.9%; p < 0.001) and csPCa ISUP GG ≥ 3 (12.6 vs. 6.2%; p = 0.04), relative to SB. After a median time follow-up of 36 months, the rates of csPCa ISUP GG ≥ 2 (6.1 vs. 4.4%; p = 0.6) and csPCa ISUP GG ≥ 3 (3.3 vs. 1.1%; p = 0.2) were similar in SB GROUP vs. TB GROUP. Moreover, in TB GROUP patients that avoided prostate biopsies because of negative baseline mpMRI (n = 145), only 4.1% exhibited csPCa ISUP GG ≥ 2 during follow-up. Moreover, none of these patients (PI-RADS ≤ 2) had csPCa ISUP GG ≥ 3.
In biopsy naïve setting, a diagnostic pathway including pre-biopsy mpMRI and TB of only PCa suspicious lesions is not associated with higher rates of csPCa during follow-up, relative to a diagnostic pathway of SB. Moreover, patients with negative baseline mpMRI could safely avoid prostate biopsies and could be followed with repeated PSA testing, since only a small proportion of them would harbor csPCa.
为了在接受两种不同诊断途径的初次活检患者中检测到临床显著前列腺癌（csPCa）的发生率：（1）SB 组（n=354）：系统随机活检（SB）与（2）TB 组（n=264）：多参数磁共振成像（mpMRI）和仅靶向 PI-RADS≥3 病变的靶向活检（TB）。PI-RADS 评分≤2 分的患者避免进行前列腺活检。
这是一项回顾性单中心研究，纳入了 618 名初次活检患者（2015-2018 年）。使用了两种不同的 csPCa 定义：（1）csPCa ISUP GG≥2（ISUP 分级组 [GG]≥2）和（2）csPCa ISUP GG≥3。使用 Kaplan-Meier 图和单变量 Cox 回归模型检测 SB 组与 TB 组中 csPCa ISUP GG≥2 和 caPCa ISUP GG≥3 的时间发生率。
初次活检时，TB 组的 csPCa ISUP GG≥2（35.3% vs. 18.9%；p<0.001）和 csPCa ISUP GG≥3（12.6% vs. 6.2%；p=0.04）的发生率高于 SB 组。中位随访 36 个月后，SB 组和 TB 组的 csPCa ISUP GG≥2（6.1% vs. 4.4%；p=0.6）和 csPCa ISUP GG≥3（3.3% vs. 1.1%；p=0.2）的发生率相似。此外，在 TB 组中，由于基线 mpMRI 为阴性而避免前列腺活检的 145 名患者中，仅 4.1%在随访期间出现 csPCa ISUP GG≥2。此外，这些患者中没有一个（PI-RADS≤2）出现 csPCa ISUP GG≥3。
在初次活检的情况下，与 SB 组相比，包括术前 mpMRI 和仅对疑似前列腺癌病变进行 TB 的诊断途径与随访期间 csPCa 的发生率增加无关。此外，由于基线 mpMRI 为阴性而避免前列腺活检的患者可以安全地避免前列腺活检，并且可以通过重复 PSA 检测进行随访，因为只有一小部分患者会发生 csPCa。
