Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Lefkos Stavros Hospital, Athens, Greece.
Department of Urology, Metropolitan General Hospital, Athens, Greece.
Eur Urol. 2022 Nov;82(5):452-457. doi: 10.1016/j.eururo.2022.07.025. Epub 2022 Aug 18.
Multiparametric magnetic resonance imaging (mpMRI) has high sensitivity but low specificity for prostate cancer (PCa) diagnosis. The aim of our systematic review was to investigate the proportion of PCa found at a repeat biopsy in patients with a negative initial prostate biopsy, despite initial positive mpMRI. Included patients had a Prostate Imaging Reporting and Data System (PI-RADS)/Likert 3-5 lesion on mpMRI prior to the initial mpMRI-targeted prostate biopsy, which was negative for PCa on histology. The main outcomes were the overall and clinically significant PCa (csPCa; International Society of Urological Pathology >1 or any provided definition) percentages at a repeat biopsy. Out of 1179 articles identified, nine studies were included (a total of 485 patients). For patients with PI-RADS 3 lesions, overall and csPCa detection percentages ranged from 0% to 80% and from 0% to 20%, respectively, while for patients with PI-RADS ≥4 lesions, the corresponding percentages were 15.4-86% and 7.7-57%. An overall cancer detection percentage of 87.5% was reported in patients with Likert 5 lesions. Limitation of our review is the small number of studies and the protocol revision that allowed studies with <50 patients. In patients with a positive MRI result and a negative initial MRI-targeted biopsy, we suggest MRI re-reading and follow-up with repeat mpMRI or the standard repeat biopsy in cases at the highest risk. PATIENT SUMMARY: Literature has shown that in men with an abnormal prostate magnetic resonance imaging (MRI) scan but a normal biopsy, a significant prostate cancer can be present. MRI scans should be double checked, followed by standard checkups or repeat prostate biopsy, especially in highly suspicious cases.
多参数磁共振成像（mpMRI）在前列腺癌（PCa）诊断中具有较高的敏感性但特异性较低。本系统评价的目的是调查在初始 mpMRI 靶向前列腺活检阴性但初始 mpMRI 阳性的患者中，重复活检时发现 PCa 的比例。纳入的患者在初始 mpMRI 靶向前列腺活检前的 mpMRI 上有前列腺成像报告和数据系统（PI-RADS）/Likert 3-5 病变，组织学上无 PCa。主要结局是重复活检时总体和临床显著前列腺癌（csPCa；国际泌尿病理学会>1 或任何提供的定义）的百分比。在确定的 1179 篇文章中，有 9 项研究被纳入（共 485 名患者）。对于 PI-RADS 3 病变患者，总体和 csPCa 的检出率范围分别为 0%至 80%和 0%至 20%，而对于 PI-RADS≥4 病变患者，相应的检出率分别为 15.4%-86%和 7.7%-57%。在 Likert 5 病变患者中，报道的总体癌症检出率为 87.5%。本综述的局限性在于研究数量较少，且方案修订后纳入了<50 例患者的研究。在 MRI 结果阳性且初始 MRI 靶向活检阴性的患者中，我们建议对 MRI 进行重新读取，并对高危患者进行重复 mpMRI 或标准重复活检随访。患者总结：文献表明，在 MRI 扫描异常但活检正常的男性中，可能存在显著的前列腺癌。MRI 扫描应进行双重检查，然后进行标准检查或重复前列腺活检，尤其是在高度可疑的情况下。
