Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
Department of Urology, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands.
World J Urol. 2023 Feb;41(2):427-434. doi: 10.1007/s00345-022-04236-4. Epub 2022 Dec 19.
Although active surveillance (AS) is recommended for low- to favorable intermediate-risk prostate cancer (PCa), risk of upgrading at radical prostatectomy (RP) is not negligible. Available studies based on systematic transrectal ultrasound biopsy might not be applicable to contemporary cohorts diagnosed with MRI-targeted biopsy (TB). The aim of the present study is to explore rates and risk factors for adverse outcomes (AO) at RP in patients with ISUP ≤ 2 PCa detected at TB with concomitant systematic biopsy (SB).
Multicenter, retrospective analysis of 475 consecutive patients with ISUP ≤ 2 PCa at MRI-TB + SB is treated with RP. AO were defined as ISUP upgrading, adverse pathology (upgrading to ISUP ≥ 3 and/or ≥ pT3 at RP, and/or pN1) (AP) or biochemical recurrence (BCR) in men with follow-up (n = 327).
The rate of ISUP upgrading, upgrading ≥ 3, and AP were 39%, 21%, and 43%. Compared to ISUP2, men with ISUP1 PCa had a higher rate of overall upgrading (27 vs. 67%, p < 0.001), but less upgrading to ≥ 3 (27 vs. 10%, p < 0.001). AP was more common when ISUP2 was detected with a combined MRI-TB + SB approach compared to considering TB (p = 0.02) or SB (p = 0.01) alone. PSA, PSA density, PI-RADS, ISUP at TB, overall biopsy ISUP and EAU classification were predictors of upgrading to ISUP ≥ 3 and AP. The 1 year BCR-free survival was 94% with no differences in BCR rates between subgroups.
Upgrading in ISUP ≤ 2 PCa remains prevalent even in men diagnosed in the MRI era. The use of MRI-TB with concomitant SB allows for the accurate identification of ISUP2 PCa and predicts the risk of AO at RP.
尽管对于低风险到中低风险前列腺癌（PCa）推荐采用主动监测（AS），但根治性前列腺切除术（RP）时发生升级的风险不可忽视。基于系统经直肠超声活检的现有研究可能不适用于基于 MRI 靶向活检（TB）诊断的当代队列。本研究旨在探讨在 MRI-TB+SB 检出的 ISUP≤2 PCa 患者中，RP 术后发生不良结局（AO）的发生率和危险因素。
对 475 例连续接受 MRI-TB+SB 治疗的 ISUP≤2 PCa 患者进行多中心回顾性分析。AO 定义为 ISUP 升级、不良病理（RP 时升级为 ISUP≥3 和/或≥pT3 和/或 pN1，AP）或生化复发（BCR）（n=327 例，有随访结果）。
ISUP 升级、升级≥3 和 AP 的发生率分别为 39%、21%和 43%。与 ISUP2 相比，ISUP1 PCa 患者整体升级率更高（27%比 67%，p<0.001），但升级至≥3 的比例较低（27%比 10%，p<0.001）。与单独考虑 TB（p=0.02）或 SB（p=0.01）相比，当联合使用 MRI-TB+SB 方法检测到 ISUP2 时，AP 更为常见。PSA、PSA 密度、PI-RADS、TB 时 ISUP、整体活检 ISUP 和 EAU 分类是升级为 ISUP≥3 和 AP 的预测因素。1 年无 BCR 生存率为 94%，各组间 BCR 率无差异。
即使在 MRI 时代诊断出的 PCa 患者中，ISUP≤2 患者的升级仍然很常见。使用 MRI-TB 联合 SB 可准确识别 ISUP2 PCa，并预测 RP 时发生 AO 的风险。
