Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Int J Urol. 2023 Jul;30(7):600-604. doi: 10.1111/iju.15188. Epub 2023 Apr 20.
The precise diagnosis of prostate cancer (PC) is crucial to avoid underdiagnosis, overdiagnosis, and overtreatment. We aimed to compare clinically significant PC (csPC) detection between MRI/ultrasound fusion-targeted prostate (TBx) compared to systematic biopsy (SBx) in biopsy-naïve Japanese men.
We included patients with suspect PC due to elevated PSA level or abnormal digital rectal examination, or both. csPC was defined as International Society Urological Pathology (ISUP) grade group ≥2 (csPC-A) and ISUP grade group ≥3 (csPC-B).
This study included 143 patients. Overall PC detection was 66.4% for SBx and 67.8% for MRI-TBx. MRI-TBx presented a significantly higher rate of csPC detection (csPC-A 67.1% vs. 58.7%, p = 0.04, and csPC-B 49.6% vs. 39.9%, p < 0.001) and significantly lower detection of non-csPC-A (0.6% vs. 6.7%). Importantly, MRI-TBx missed 4.9% (7/143) of csPC-A and only 0.7% (1/143) of csPC-B. On the other hand, SBx alone missed 13.3% (19/143) of csPC-A and 4.2% (6/143) of csPC-B.
MRI-TBx significantly outperformed 12-cores SBx for csPC detection and decreased non-csPC detection in biopsy-naive men. Performing MRI-TBx without SBx would have missed some csPC, supporting that MRI-TBx synergizes with SBx to increase csPC detection.
前列腺癌（PC）的精确诊断对于避免漏诊、过度诊断和过度治疗至关重要。我们旨在比较 MRI/超声融合靶向前列腺（TBx）与系统活检（SBx）在初次活检的日本男性中对临床显著 PC（csPC）的检测效果。
我们纳入了因 PSA 水平升高或直肠指检异常或两者兼有的疑似 PC 患者。csPC 定义为国际泌尿病理学会（ISUP）分级组≥2（csPC-A）和 ISUP 分级组≥3（csPC-B）。
本研究共纳入 143 例患者。SBx 总体 PC 检出率为 66.4%，MRI-TBx 为 67.8%。MRI-TBx 检测 csPC 的阳性率显著更高（csPC-A 为 67.1% vs. 58.7%，p=0.04，csPC-B 为 49.6% vs. 39.9%，p<0.001），而非 csPC-A 的检出率显著更低（0.6% vs. 6.7%）。重要的是，MRI-TBx 漏诊了 4.9%（7/143）的 csPC-A 和仅 0.7%（1/143）的 csPC-B。另一方面，SBx 单独漏诊了 13.3%（19/143）的 csPC-A 和 4.2%（6/143）的 csPC-B。
MRI-TBx 显著提高了初次活检男性中 csPC 的检测率，降低了非 csPC 的检出率。不进行 SBx 而单独进行 MRI-TBx 可能会漏诊一些 csPC，支持 MRI-TBx 与 SBx 联合使用以提高 csPC 的检出率。
