Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
J Urol. 2021 May;205(5):1352-1360. doi: 10.1097/JU.0000000000001547. Epub 2020 Dec 24.
Active surveillance for patients with low and intermediate risk prostate cancers is becoming a more utilized option in recent years. However, the use of magnetic resonance imaging and imaging-targeted biopsy for monitoring grade progression has been poorly studied in this population. We aim to define the utility of magnetic resonance imaging-targeted biopsy and systematic biopsy in an active surveillance population.
Between July 2007 and January 2020, patients with diagnosed prostate cancer who elected active surveillance were monitored with prostate magnetic resonance imaging, imaging-targeted biopsy and standard systematic biopsy. Patients were eligible for surveillance if diagnosed with any volume Gleason grade 1 disease and select Gleason grade 2 disease. Grade progression (Gleason grade 1 to ≥2 disease and Gleason grade 2 to ≥3 disease) for each biopsy modality was measured at 2 years, 4 years and 6+ years.
In total, 369 patients had both magnetic resonance imaging-targeted and systematic biopsy and were surveilled for at least 1 year. At 2 years, systematic biopsy, magnetic resonance imaging-targeted biopsy and combined biopsy (systematic+imaging-targeted) detected grade progression in 44 patients (15.9%), 73 patients (26.4%) and 90 patients (32.5%), respectively. Magnetic resonance imaging-targeted biopsy detected more cancer grade progression compared to systematic biopsy in both the low and intermediate risk populations (p <0.001). Of all 90 grade progressions at the 2-year time point 46 (51.1%) were found by magnetic resonance imaging-targeted biopsy alone and missed by systematic biopsy.
Magnetic resonance imaging-targeted biopsy detected significantly more grade progressions in our active surveillance cohort compared to systematic biopsy at 2 years. Our results provide compelling evidence that prostate magnetic resonance imaging and imaging-targeted biopsy should be included in contemporary active surveillance protocols.
近年来，对低危和中危前列腺癌患者进行主动监测的方法越来越被广泛应用。然而，在该人群中，磁共振成像（MRI）和基于影像的靶向活检在监测分级进展方面的应用研究甚少。本研究旨在评估 MRI 靶向活检和系统活检在主动监测人群中的应用价值。
本研究纳入了 2007 年 7 月至 2020 年 1 月间选择主动监测的前列腺癌患者，通过 MRI 靶向活检和标准系统活检对其进行监测。如果患者被诊断为任何体积的 Gleason 评分 1 级疾病和选择的 Gleason 评分 2 级疾病，则有资格进行监测。在 2 年、4 年和 6 年以上，测量每种活检方式的分级进展（Gleason 评分 1 级至≥2 级和 Gleason 评分 2 级至≥3 级）。
共有 369 例患者同时接受了 MRI 靶向活检和系统活检，并至少随访 1 年。在 2 年时，系统活检、MRI 靶向活检和联合活检（系统活检+MRI 靶向活检）分别检测到 44 例（15.9%）、73 例（26.4%）和 90 例（32.5%）患者发生分级进展。MRI 靶向活检在低危和中危人群中均比系统活检检测到更多的癌症分级进展（p<0.001）。在 2 年时的所有 90 例分级进展中，46 例（51.1%）仅由 MRI 靶向活检检出，而系统活检漏诊。
与系统活检相比，MRI 靶向活检在我们的主动监测队列中在 2 年内更能显著检测到分级进展。我们的研究结果提供了有力的证据，表明前列腺 MRI 和基于影像的靶向活检应该纳入当代主动监测方案。
