经会阴多参数磁共振成像-超声融合靶向前列腺活检在较小前列腺中检测临床显著前列腺癌。

Detection of clinically significant prostate cancer by transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in smaller prostates.

机构信息

Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

出版信息

Urol Oncol. 2022 Oct;40(10):451.e9-451.e14. doi: 10.1016/j.urolonc.2022.07.011. Epub 2022 Aug 23.

DOI:10.1016/j.urolonc.2022.07.011

PMID:36008257

Abstract

PURPOSE

Transperineal (TP) multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) has been shown to detect more clinically significant (cs) prostate cancer (PCa) than standard template biopsies (SBx). Current data supports the inclusion of both TBx and SBx in obtaining an optimal csPCa detection rate. We compared csPCa detection rates in patients with different prostate volumes to examine the benefit of performing TBx in smaller prostates through the TP approach.

METHODS

We identified all men who with suspicious lesions on mpMRI and underwent TP TBx (3-core) and concomitant SBx (20-core) in our single hospital from September 2019 to February 2021. Clinical, MRI and biopsy pathological characteristics were evaluated and compared between TBx and SBx. Grade group 2 or greater prostate adenocarcinoma was defined as csPCa.

RESULTS

Three hundred and one (n = 301) men were included. The median prostate volume by MRI was 45 ml. The patients were divided by prostate volume into three groups: ≤30ml group (19.9%), >30 to ≤45 ml group (31.3%) and >45ml group (48.8%). Patients in the ≤30ml group showed significantly higher frequency of combined (both TBx and/or SBx) csPCa detection rate (65.0%) than patients in the >45ml group (39.5%) but similar frequency to the >30 to ≤45 ml group (54.2%,). By TBx only (55.0% vs 27.9%) or by SBx only (56.7% vs. 34.0%), patients in the ≤30ml group consistently showed significantly higher rates of csPCa detection than patients in the >45 ml group. In the ≤30ml group, the detection rate of csPCa was comparable by TBx, SBx or when combined. Four of 6 csPCa cases missed by TBx but detected by SBx were present at the base location.

CONCLUSION

Our data suggest that performing TBx with limited additional cores may potentially achieve the same csPCa detection rate as the combined SBx and TBx in smaller prostates.

摘要

目的

经会阴（TP）多参数磁共振成像（mpMRI）靶向活检（TBx）已被证明比标准模板活检（SBx）能检测到更多的临床显著（cs）前列腺癌（PCa）。目前的数据支持在获得最佳 csPCa 检测率的同时，既包括 TBx 又包括 SBx。我们比较了不同前列腺体积患者的 csPCa 检出率，以检查通过 TP 途径在较小前列腺中进行 TBx 的益处。

方法

我们在 2019 年 9 月至 2021 年 2 月期间，从我们的一家医院中确定了所有在 mpMRI 上有可疑病变并接受 TP TBx（3 核）和同时 SBx（20 核）的男性。评估和比较了 TBx 和 SBx 之间的临床、MRI 和活检病理特征。定义分级组 2 或更高的前列腺腺癌为 csPCa。

结果

共纳入 301 名男性。MRI 测量的前列腺体积中位数为 45ml。根据前列腺体积将患者分为三组：≤30ml 组（19.9%）、>30 至≤45ml 组（31.3%）和>45ml 组（48.8%）。≤30ml 组的患者联合（TBx 和/或 SBx）csPCa 检出率（65.0%）显著高于>45ml 组（39.5%），但与>30 至≤45ml 组（54.2%）相似。仅通过 TBx（55.0%比 27.9%）或仅通过 SBx（56.7%比 34.0%），≤30ml 组的患者 csPCa 检出率显著高于>45ml 组。在≤30ml 组中，通过 TBx、SBx 或联合检查，csPCa 的检出率相当。在通过 SBx 检测到但通过 TBx 漏诊的 6 例 csPCa 中，有 4 例位于前列腺底部。