Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padova, Italy.
Department of Urology, Institut Mutualiste Montsouris, Paris, France.
Eur Urol Focus. 2023 Jul;9(4):621-628. doi: 10.1016/j.euf.2023.01.016. Epub 2023 Feb 4.
The concordance rates of transperineal (TP) versus transrectal (TR) prostate biopsies with radical prostatectomy (RP) specimen have been assessed poorly in men diagnosed with magnetic resonance imaging (MRI)-targeted biopsy (TBx).
To evaluate International Society of Urological Pathology (ISUP) concordance rates between the final pathology at RP and MRI-TBx or MRI-TBx + random biopsy (RB) according to the biopsy approach.
DESIGN, SETTING, AND PARTICIPANTS: A multi-institutional database included patients diagnosed with TP or TR treated with RP.
TP-TBx or TR-TBx of the prostate.
The ISUP grade at biopsy was compared with the final pathology. A multivariable logistic regression analysis (MVA) was performed to assess the association between the biopsy approach (TP-TBx vs TR-TBx) and ISUP upgrading, downgrading, concordance, and clinically relevant increase (CRI).
Overall, 752 (59%) versus 530 (41%) patients underwent TR versus TP. At the MVA, TP-TBx was an independent predictor of upgrading (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.9, p < 0.01) and improved concordance relative to the final pathology (OR 1.7, 95% CI 1.2-2.5, p < 0.01) after adjusting for age, cT stage, Prostate Imaging Reporting and Data System, number of targeted cores, prostate-specific antigen, and prostate volume. Moreover, TP-TBx was associated with a lower risk of CRI than TR-TBx (OR 0.7, p < 0.01). This held true when considering patients who underwent MRI-TBx + RB (OR 0.6, p < 0.01). The inclusion of men who had RP represents a potential selection bias.
The adoption of TP-TBx compared with TR-TBx may reduce the risk of upgrading and improve the concordance of biopsy grade with the final pathology. The TP approach decreases the odds of CRI with improved patient selection for the correct active treatment.
In this report, we evaluated whether transperineal (TP) targeted biopsy (TBx) may improve the concordance of clinically significant prostate cancer with the final pathology in comparison with transrectal (TR) TBx in a large worldwide population. We found that TP-TBx might increase concordance compared with TR-TBx. Adding random biopsies to target one increases accuracy; however, concordance with the final pathology is overall suboptimal even with the TP approach.
在接受磁共振成像（MRI）靶向活检（TBx）诊断的男性中，经会阴（TP）与经直肠（TR）前列腺活检与根治性前列腺切除术（RP）标本的一致性率评估不佳。
根据活检方法，评估 RP 时最终病理与 MRI-TBx 或 MRI-TBx+随机活检（RB）之间国际泌尿病理学会（ISUP）的一致性率。
设计、地点和参与者：多机构数据库包括接受 RP 治疗的经 TP 或 TR 诊断为 TP 或 TR 的患者。
TP-TBx 或 TR-TBx 前列腺。
比较活检时的 ISUP 分级与最终病理。采用多变量逻辑回归分析（MVA）评估活检方法（TP-TBx 与 TR-TBx）与 ISUP 升级、降级、一致性和临床相关增加（CRI）之间的关联。
总体而言，59%（752 例）患者接受 TR 活检，41%（530 例）患者接受 TP 活检。在 MVA 中，TP-TBx 是升级的独立预测因素（优势比 [OR] 0.6，95%置信区间 [CI] 0.4-0.9，p<0.01），与最终病理相比，一致性得到改善（OR 1.7，95% CI 1.2-2.5，p<0.01），调整年龄、cT 期、前列腺成像报告和数据系统、靶向核心数量、前列腺特异性抗原和前列腺体积后。此外，与 TR-TBx 相比，TP-TBx 与 CRI 风险较低相关（OR 0.7，p<0.01）。当考虑接受 MRI-TBx+RB 的患者时，这仍然成立（OR 0.6，p<0.01）。包括接受 RP 的男性可能存在选择偏倚。
与 TR-TBx 相比，采用 TP-TBx 可能降低升级风险并提高活检分级与最终病理的一致性。TP 方法通过改善患者选择，降低了正确积极治疗的 CRI 几率。
在这项报告中，我们评估了在全球范围内的大量人群中，与经直肠（TR）TBx 相比，经会阴（TP）靶向活检（TBx）是否可以提高与最终病理一致的具有临床意义的前列腺癌的一致性。我们发现，与 TR-TBx 相比，TP-TBx 可能会提高一致性。增加靶向活检的随机活检可以提高准确性；然而，即使采用 TP 方法，与最终病理的一致性总体上也不佳。
