Görtz Magdalena, Huber Ann-Kathrin, Linz Tim, Schwab Constantin, Stenzinger Albrecht, Goertz Lukas, Bonekamp David, Schlemmer Heinz-Peter, Hohenfellner Markus
Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany.
Junior Clinical Cooperation Unit 'Multiparametric Methods for Early Detection of Prostate Cancer', German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
Diagnostics (Basel). 2023 May 17;13(10):1761. doi: 10.3390/diagnostics13101761.
A negative multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy in patients with suspected prostate cancer (PC) results in clinical uncertainty, as the biopsy can be false negative. The clinical challenge is to determine the optimal follow-up and to select patients who will benefit from repeat biopsy. In this study, we evaluated the rate of significant PC (sPC, Gleason score ≥7) and PC detection in patients who received a follow-up mpMRI/ultrasound-guided biopsy for persistent PC suspicion after a negative mpMRI/ultrasound-guided biopsy. We identified 58 patients at our institution that underwent repeat targeted biopsy in case of PI-RADS lesions and systematic saturation biopsy between 2014 and 2022. At the initial biopsy, the median age was 59 years, and the median prostate specific antigen level was 6.7 ng/mL. Repeat biopsy after a median of 18 months detected sPC in 3/58 (5%) patients and Gleason score 6 PC in 11/58 (19%). Among 19 patients with a downgraded PI-RADS score at the follow-up mpMRI, none had sPC. In conclusion, men with an initial negative mpMRI/ultrasound-guided biopsy had a high likelihood of not harboring sPC at repeat biopsy (95%). Due to the small size of the study, further research is recommended.
对于疑似前列腺癌（PC）的患者，多参数磁共振成像（mpMRI）引导下的前列腺穿刺活检结果为阴性会导致临床不确定性，因为活检可能出现假阴性。临床面临的挑战是确定最佳随访方案，并选择能从重复活检中获益的患者。在本研究中，我们评估了在mpMRI/超声引导下首次活检为阴性但仍持续怀疑前列腺癌的患者中，接受随访的mpMRI/超声引导下活检后显著前列腺癌（sPC，Gleason评分≥7）的发生率和前列腺癌检出率。我们确定了2014年至2022年间在我们机构因PI-RADS病变接受重复靶向活检和系统饱和活检的58例患者。初次活检时，患者的中位年龄为59岁，前列腺特异性抗原水平中位数为6.7 ng/mL。中位18个月后的重复活检在3/58（5%）的患者中检测到sPC，在11/58（19%）的患者中检测到Gleason评分6分的前列腺癌。在随访mpMRI时PI-RADS评分降低的19例患者中，无一例患有sPC。总之，初次mpMRI/超声引导下活检为阴性的男性在重复活检时患sPC的可能性很低（95%）。由于本研究规模较小，建议进一步开展研究。
