Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, New York.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Urol. 2021 Mar;205(3):748-754. doi: 10.1097/JU.0000000000001424. Epub 2020 Oct 20.
A benign magnetic resonance imaging targeted prostate biopsy in the setting of a PI-RADS™ 4/5 abnormality presents a clinical dilemma for future management. We evaluated benign histological features on magnetic resonance imaging targeted prostate biopsy to determine if they predict the likelihood of missed cancer on subsequent biopsy.
Between June 2012 and September 2016, 1,595 men were enrolled in a prospective study of magnetic resonance imaging targeted and systematic biopsy outcomes. We re-reviewed pathology from benign biopsies of PI-RADS 4/5 abnormalities and divided them into 5 groups for comparison to outcomes of clinical followup: inflammation (38%), stroma/glandular hyperplasia (9%), normal prostate tissue (28%), atypical small acinar proliferation/high grade prostatic intraepithelial neoplasia (9%) and cancer in adjacent systematic cores (16%).
Of 497 men 88 (18%) with PI-RADS 4/5 abnormality prior to initial biopsy had no cancer on magnetic resonance imaging targeted prostate biopsy. On followup, 45 men underwent repeat magnetic resonance imaging: 12 (27%) had persistent PI-RADS 4/5 abnormalities, 17 (38%) had PI-RADS 2/3, 16 (35%) had PI-RADS 1. On repeat magnetic resonance imaging targeted prostate biopsy, cancer was found in 62.5% of men with PI-RADS 4/5 and 23% of men with PI-RADS 2/3. Histological groups on initial biopsy were not predictive of the likelihood of PI-RADS downgrade on repeat magnetic resonance imaging or cancer detection on repeat biopsy.
Among men with no cancer on magnetic resonance imaging targeted prostate biopsy performed for PI-RADS abnormality, downgrade of PI-RADS score is noted in 73% on repeat magnetic resonance imaging. Persistence of PI-RADS 4/5 predicts a higher risk of missed cancer, warranting prompt re-biopsy. While histological findings such as inflammation may underlie some PI-RADS 4/5 abnormalities, initial histology is a poor predictor of cancer likelihood on repeat biopsy.
在 PI-RADS™4/5 异常的情况下，良性磁共振成像靶向前列腺活检带来了临床决策难题。我们评估了磁共振成像靶向前列腺活检中的良性组织学特征，以确定其是否可预测后续活检中遗漏癌症的可能性。
在 2012 年 6 月至 2016 年 9 月期间，有 1595 名男性参与了一项关于磁共振成像靶向和系统活检结果的前瞻性研究。我们重新审查了 PI-RADS 4/5 异常的良性活检的病理学，并将其分为 5 组进行比较，以了解与临床随访结果的关系：炎症（38%）、基质/腺体增生（9%）、正常前列腺组织（28%）、非典型小腺泡增生/高级别前列腺上皮内瘤变（9%）和相邻系统核心中的癌症（16%）。
在初始活检前有 497 名男性（88%）PI-RADS 4/5 异常，磁共振成像靶向前列腺活检未见癌症。随访时，45 名男性接受了重复磁共振成像检查：12 名（27%）持续存在 PI-RADS 4/5 异常，17 名（38%）PI-RADS 2/3，16 名（35%）PI-RADS 1。在重复磁共振成像靶向前列腺活检中，PI-RADS 4/5 男性中有 62.5%和 PI-RADS 2/3 男性中有 23%发现癌症。初始活检的组织学分组不能预测重复磁共振成像时 PI-RADS 评分下降或重复活检时癌症检出的可能性。
在 PI-RADS 异常的磁共振成像靶向前列腺活检中未见癌症的男性中，73%的男性在重复磁共振成像时 PI-RADS 评分下降。PI-RADS 4/5 的持续存在预测了漏诊癌症的风险更高，需要及时进行再次活检。尽管炎症等组织学发现可能是某些 PI-RADS 4/5 异常的基础，但初始组织学对重复活检时癌症可能性的预测较差。
