Department of Urology, Hospital Claude Huriez, CHRU Lille, France; Université de Lille 2, Faculté de médecine Henri Warembourg, Lille, France.
UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
Prog Urol. 2021 Mar;31(3):147-157. doi: 10.1016/j.purol.2020.09.025. Epub 2020 Nov 12.
Multiparametric magnetic resonance imaging (MRI) is now recommended before performing prostate biopsies, looking for suspicious lesions to perform targeted biopsies (TB). However, the association or exclusive performance of systematic biopsies (SB), criticized for its morbidity and for the detection of insignificant cancers, remains debated.
To perform a literature review to answer three questions: (1) In the presence of a suspicious MRI lesion, should we always perform SB in addition to TB? (2) Can we avoid SB when considering focal treatment? (3) Is there an increase in adverse events when associating SB with TB?
A non-systematic literature review was carried out on Medline in April 2020 using the keywords "MRI", "PROSTATE CANCER", "SYSTEMATIC BIOPSY", "TARGETED BIOPSY", "ADVERSE EVENTS". The references of the selected articles were analyzed for additional articles. Selection of Studies published in the last five years were analyzed and retained if the available data made it possible to answer one of the three questions asked.
In biopsy-naive patients, the added value of SB to TB for detection of significative cancer varied from +5 to+7% and was reduced to +1 to +3% in the case of a previous series of negative biopsies. For patients under active surveillance, this added value was higher, ranging from +8% to +17%. MRI has a negative predictive value of 85 to 95%, but this value drops to 55% for the detection of secondary or tertiary foci. The use of SB is necessary if focal treatment is considered. Serious complications from biopsies requiring hospitalization range from 1.4 to 6.9% and are increased by the number of previous biopsy series performed more than by the number of biopsies per series.
In the presence of a suspicious MRI lesion, SB is indicated in addition to TB but can be discussed in patients with previous negative biopsies. They are necessary if focal treatment is considered to aid surgical planning. Severe complications from biopsies do not seem to increase when SB are associated to TB, but rather with the number of biopsy series performed.
多参数磁共振成像（MRI）现在被推荐用于前列腺活检前，寻找可疑病变以进行靶向活检（TB）。然而，系统活检（SB）的相关性或单独执行，因其发病率和对无意义癌症的检测而受到批评，仍然存在争议。
进行文献综述以回答三个问题：（1）在存在可疑 MRI 病变的情况下，我们是否应该总是在进行 TB 的基础上再进行 SB？（2）在考虑局部治疗时，我们能否避免 SB？（3）将 SB 与 TB 联合使用是否会增加不良事件的发生？
2020 年 4 月，在 Medline 上使用“MRI”、“前列腺癌”、“系统活检”、“靶向活检”、“不良事件”等关键词进行了非系统性文献综述。对选定文章的参考文献进行了分析，以获取更多文章。分析了过去五年发表的研究，并保留了那些能够回答三个问题之一的研究。
在活检初治患者中，SB 对 TB 检测有意义癌症的附加价值从+5%到+7%不等，而在前一次活检系列阴性的情况下，该值降低到+1%到+3%。对于处于积极监测下的患者，这一附加价值更高，范围从+8%到+17%。MRI 的阴性预测值为 85%至 95%，但对于检测二级或三级病灶，该值下降到 55%。如果考虑进行局部治疗，则需要进行 SB。需要住院治疗的活检严重并发症的范围为 1.4%至 6.9%，且与进行的活检系列数量有关，而与每个系列的活检数量无关。
在存在可疑 MRI 病变的情况下，除了 TB 之外，还应进行 SB，但对于有既往阴性活检的患者可以进行讨论。如果考虑进行局部治疗，则需要进行 SB。将 SB 与 TB 联合使用似乎不会增加活检的严重并发症，但会随着活检系列数量的增加而增加。
