GRC no 5, Predictive Onco-Urology, Sorbonne University, AP-HP, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, UrologyParis Cedex 13, France.
Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France.
World J Urol. 2022 Jul;40(7):1661-1668. doi: 10.1007/s00345-022-04013-3. Epub 2022 Apr 28.
To perform a dynamic evaluation of the prostate cancer (PCa) detection rate according to the biopsy strategy over 10 years of practice in a single institution that pioneered MRI-targeted fusion biopsy (MRI-TB).
This stage 4 IDEAL study prospectively included all consecutive patients who underwent transrectal prostate biopsy for clinically suspected PCa between January 2010 and November 2020. Patients with positive MRI (PIRADS score ≥ 3) underwent both MRI-TB and systematic biopsy (SB) while those with negative MRI (PIRADS score < 3) underwent SB only. The main outcome was the evolution of the detection rate of clinically relevant PCa (csPCa; grade ≥ 2). The secondary outcome was the change in PCa detection rate according to the biopsy method.
A total of 2942 men underwent prostate MRI and a prostate biopsy: 2322 underwent MRI-TB and 620 had SB only. The detection rate of csPCa increased 2.5-fold from 23 to 58%. The detection rate of PCa and csPCa was significantly higher in patients who underwent MRI-TB compared to those who underwent SB only (67% vs. 52% and 40% vs. 32%, respectively (P < 0.001 for both comparisons)). The number of csPCa diagnosed by MRI-TB increased linearly over the study period and represented the majority of PCa diagnoses after 2016.
Implementation of MRI-TB in patients with positive MRI led to improved detection of csPCa.
在一家率先开展 MRI 靶向融合活检（MRI-TB）的机构，对 10 多年来的活检策略进行前列腺癌（PCa）检出率的动态评估。
本 4 期 IDEAL 研究前瞻性纳入了 2010 年 1 月至 2020 年 11 月期间因临床疑似 PCa 而接受经直肠前列腺活检的所有连续患者。MRI 阳性（PI-RADS 评分≥3）的患者行 MRI-TB 和系统活检（SB），MRI 阴性（PI-RADS 评分<3）的患者仅行 SB。主要结局为临床相关 PCa（csPCa；分级≥2）检出率的变化。次要结局为根据活检方法 PCa 检出率的变化。
共 2942 名男性接受了前列腺 MRI 和前列腺活检：2322 名接受了 MRI-TB，620 名仅接受了 SB。csPCa 的检出率从 23%增加到 58%，增加了 2.5 倍。与仅接受 SB 的患者相比，接受 MRI-TB 的患者的 PCa 和 csPCa 检出率显著更高（分别为 67% vs. 52%和 40% vs. 32%（两者比较 P<0.001））。MRI-TB 诊断的 csPCa 数量在研究期间呈线性增加，且在 2016 年后成为 PCa 诊断的主要方法。
在 MRI 阳性的患者中实施 MRI-TB 可提高 csPCa 的检出率。
