Department of Urology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.
Asian J Androl. 2023 Jan-Feb;25(1):43-49. doi: 10.4103/aja2021128.
Magnetic resonance imaging (MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s) on MRI. The role of concurrent systematic in addition to targeted biopsies is currently unclear. Using our prospectively maintained database, we identified men with at least one Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesion who underwent targeted and/or systematic biopsies from May 2016 to May 2020. Clinically significant prostate cancer (csPCa) was defined as any Gleason grade group ≥2 cancer. Of 545 patients who underwent MRI fusion-targeted biopsy, 222 (40.7%) were biopsy naïve, 247 (45.3%) had previous prostate biopsy(s), and 76 (13.9%) had known prostate cancer undergoing active surveillance. Prostate cancer was more commonly found in biopsy-naïve men (63.5%) and those on active surveillance (68.4%) compared to those who had previous biopsies (35.2%; both P < 0.001). Systematic biopsies provided an incremental 10.4% detection of csPCa among biopsy-naïve patients, versus an incremental 2.4% among those who had prior negative biopsies. Multivariable regression found age (odds ratio [OR] = 1.03, P = 0.03), prostate-specific antigen (PSA) density ≥0.15 ng ml (OR = 3.24, P < 0.001), prostate health index (PHI) ≥35 (OR = 2.43, P = 0.006), higher PI-RADS score (vs PI-RADS 3; OR = 4.59 for PI-RADS 4, and OR = 9.91 for PI-RADS 5; both P < 0.001) and target lesion volume-to-prostate volume ratio ≥0.10 (OR = 5.26, P = 0.013) were significantly associated with csPCa detection on targeted biopsy. In conclusion, for men undergoing MRI fusion-targeted prostate biopsies, systematic biopsies should not be omitted given its incremental value to targeted biopsies alone. The factors such as PSA density ≥0.15 ng ml, PHI ≥35, higher PI-RADS score, and target lesion volume-to-prostate volume ratio ≥0.10 can help identify men at higher risk of csPCa.
磁共振成像（MRI）靶向前列腺活检是 MRI 可疑病灶男性的推荐检查方法。同时进行系统和靶向活检的作用目前尚不清楚。我们使用前瞻性维护的数据库，确定了 2016 年 5 月至 2020 年 5 月期间至少有一个前列腺成像报告和数据系统（PI-RADS）≥3 病变的接受靶向和/或系统活检的男性。临床显著前列腺癌（csPCa）定义为任何 Gleason 分级组≥2 癌症。在 545 名接受 MRI 融合靶向活检的患者中，222 名（40.7%）为初次活检，247 名（45.3%）有前列腺活检史，76 名（13.9%）为正在接受主动监测的已知前列腺癌。与有既往活检史的患者（35.2%；均 P < 0.001）相比，初次活检的患者（63.5%）和正在接受主动监测的患者（68.4%）更常发现前列腺癌。系统活检可使初次活检患者中 csPCa 的检出率增加 10.4%，而在有既往阴性活检史的患者中仅增加 2.4%。多变量回归发现年龄（比值比[OR] = 1.03，P = 0.03）、前列腺特异性抗原（PSA）密度≥0.15 ng/ml（OR = 3.24，P < 0.001）、前列腺健康指数（PHI）≥35（OR = 2.43，P = 0.006）、更高的 PI-RADS 评分（与 PI-RADS 3 相比；PI-RADS 4 的 OR = 4.59，PI-RADS 5 的 OR = 9.91；均 P < 0.001）和目标病变体积与前列腺体积比≥0.10（OR = 5.26，P = 0.013）与靶向活检中 csPCa 的检出显著相关。总之，对于接受 MRI 融合靶向前列腺活检的男性，由于系统活检单独对靶向活检具有增量价值，因此不应省略。PSA 密度≥0.15 ng/ml、PHI≥35、更高的 PI-RADS 评分和目标病变体积与前列腺体积比≥0.10 等因素有助于识别更高风险的 csPCa 男性。
