Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany.
Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany.
World J Urol. 2023 Jan;41(1):19-25. doi: 10.1007/s00345-022-04230-w. Epub 2022 Dec 7.
Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution.
Two hundred and fifty-nine men with PI-RADS 3-5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2.
CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p < 0.001). However, TB showed higher efficiency, defined as CDR per biopsy core, for PCA and csPCA in PI-RADS 4-5 rated patients (p < 0.001). Concordance between biopsy and prostatectomy grading was highest in CB with misdiagnosis of csPCA in 25% of men. TB missed cancer attributed to the index lesion in 10.2% and underestimated csPCA in 7%. In these cases, 76% of csPCA were detected and 85% were upgraded to csPCA by SB in adjacent sectors.
SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.
附加系统活检（SB）有助于在 MRI 靶向活检（TB）中发现前列腺癌（PCA）。然而，其原因尚不清楚。我们比较了 TB、SB 和联合方法（CB）在活检初筛男性中的表现，以确定 SB 在肿瘤分级和空间肿瘤分布方面的附加价值。
共纳入 259 名 PI-RADS 3-5 级病变的活检初筛男性。前瞻性收集数据，并比较了患者和病变水平的癌症检出率（CDR）。从活检到前列腺切除术标本中确定了 Gleason 分级升级（n=56；21.6%）和降级。临床显著癌症（csPCA）定义为 Gleason 分级≥2。
基于 PI-RADS 分类 3、4 和 5 的 CB 对 PCA 的 CDR 分别为 24%、72%和 98%和 17%、64%和 96%。CB 比 TB 检出更多的 PCA 和 csPCA（p<0.001）。然而，在 PI-RADS 4-5 评分患者中，TB 对 PCA 和 csPCA 的每活检核心检出效率更高（p<0.001）。活检和前列腺切除术分级之间的一致性在 CB 中最高，其中 25%的男性 csPCA 被误诊。TB 漏诊了 10.2%的肿瘤归因于索引病变，低估了 7%的 csPCA。在这些情况下，76%的 csPCA 由 SB 在相邻区域检测到，85%的 csPCA 升级为 csPCA。
在不增加诊断不确定性的情况下，SB 不能安全地增加。当 TB 漏诊 csPCA 时，SB 则在接近 MRI 靶向病变的部位检出。因此，在可管理的风险范围内，周边活检可能会以更高的效率取代 12 针 SB。
