对于 PI-RADS≥3 的患者，靶向磁共振成像/经直肠超声融合前列腺活检是否足以检测前列腺癌：一项前瞻性、随机临床试验的结果。
Is targeted magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy enough for the detection of prostate cancer in patients with PI-RADS ≥3: Results of a prospective, randomized clinical trial.
机构信息
Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
出版信息
J Cancer Res Ther. 2020;16(7):1698-1702. doi: 10.4103/jcrt.JCRT_1495_20.
OBJECTIVE
To evaluate targeted magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion prostate biopsy versus systematic prostate biopsy and the two approaches combined for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in our center.
PATIENTS AND METHODS
From September 2018 to June 2020, a total of 161 patients with PI-RADS ≥3 were enrolled in this study. They were randomly to undergo either systematic prostate biopsy (systematic group) or targeted MRI/TRUS fusion prostate biopsy + systematic prostate biopsy (combined group). The clinical data and pathological results of biopsies were analyzed.
RESULTS
The detection rate of PCa by targeted MRI/TRUS fusion prostate biopsy was higher than systematic prostate biopsy (38/81 vs. 33/81) in combinated group, but there was no significantly difference. The PCa detection rate in combinated group was significantly higher than systematic group (47/81 vs. 34/80, P = 0.049). There were 40 patients in combinated group and 22 patients in systematic group diagnosed as csPCa, respectively. The ratio of detected csPCa was much higher in combinated group (P = 0.032). In Gleason score no more than 6, the detected ratio of targeted MRI/TRUS fusion prostate biopsy was significantly lower than systematic biopsies in combinated group (P = 0.044). While, in Gleason score higher than 6, the detected ratios of targeted MRI/TRUS fusion prostate biopsy were all higher than systematic biopsies.
CONCLUSIONS
Among patients with PI-RADS ≥ 3, targeted MRI/TRUS fusion prostate biopsy is superior to systematic prostate biopsy in the detection rate of PCa and csPCa, but it still misses some PCa patients, including csPCa. Combining targeted MRI/TRUS fusion prostate biopsy and systematic prostate biopsy can led to more detection of all PCas, especially csPCa.
目的
评估靶向磁共振成像/经直肠超声（MRI/TRUS）融合前列腺活检与系统前列腺活检以及这两种方法相结合在我们中心检测前列腺癌（PCa）和临床显著 PCa（csPCa）的效果。
方法
本研究共纳入 2018 年 9 月至 2020 年 6 月 161 例 PI-RADS≥3 的患者。他们被随机分为系统前列腺活检（系统组）或靶向 MRI/TRUS 融合前列腺活检+系统前列腺活检（联合组）。分析活检的临床资料和病理结果。
结果
靶向 MRI/TRUS 融合前列腺活检检测 PCa 的阳性率高于系统前列腺活检（联合组 38/81 对 33/81），但差异无统计学意义。联合组 PCa 的检出率明显高于系统组（47/81 对 34/80，P=0.049）。联合组有 40 例，系统组有 22 例诊断为 csPCa。联合组 csPCa 的检出率明显更高（P=0.032）。在 Gleason 评分≤6 时，联合组靶向 MRI/TRUS 融合前列腺活检的检出率明显低于系统活检（P=0.044）。而在 Gleason 评分>6 时，靶向 MRI/TRUS 融合前列腺活检的检出率均高于系统活检。
结论
在 PI-RADS≥3 的患者中，靶向 MRI/TRUS 融合前列腺活检在 PCa 和 csPCa 的检出率方面优于系统前列腺活检，但仍会漏诊部分 PCa 患者，包括 csPCa。结合靶向 MRI/TRUS 融合前列腺活检和系统前列腺活检可提高所有 PCa，特别是 csPCa 的检出率。
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