Choi Young Hyo, Lee Chung Un, Song Wan, Chang Jeong Byong, Seo Seong Il, Jeon Seong Soo, Lee Hyun Moo, Jeon Hwang Gyun, Lee Seung-Ju
Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Prostate Int. 2023 Jun;11(2):100-106. doi: 10.1016/j.prnil.2022.12.003. Epub 2022 Dec 14.
We assessed the ability of the combination of multiparametric magnetic resonance imaging (mpMRI) and transperineal template-guided mapping biopsy (TTMB) to determine the eligibility for focal therapy (FT) (hemiablation) in men and compared it with that of histology from radical prostatectomy (RP) specimens.
In this study, 120 men who underwent mpMRI, TTMB, and RP in a single tertiary center from May 2017 to June 2021 were analyzed. The criteria of hemiablation eligibility were unilateral low-to intermediate-risk prostate cancer (limited to a maximum of International Society of Urological Pathology (ISUP) grade group 3 and prostate-specific antigen (PSA) <20 ng/mL) and clinical stage ≤T2. Evidence of non-organ-confined disease or contralateral Prostate Imaging Reporting and Data System (PI-RADS) v2 score ≥4 on mpMRI was classified as ineligible for hemiablation. Clinically significant cancer at RP was defined as any of the following: (1) ISUP grade group 1 with tumor volume ≥1.3 mL; (2) ISUP grade group ≥2; or (3) the presence of advanced stage (≥pT3).
Of the 120 men, data of 52 men who met the selection criteria for hemiablation were compared with final RP findings. Of these 52 men, 42 (80.7%) could be considered suitable for hemiablation on RP. The sensitivity, specificity, and accuracy of mpMRI and TTMB in predicting FT eligibility were 80.7%, 85.1%, and 82.5%, respectively. The rate of undetected contralateral significant cancer was 10 (19.2%) on mpMRI and TTMB. Six had bilateral significant cancer and four had small volumes of ISUP grade group ≥2.
The combination of mpMRI and TTMB substantially improves the prediction of potential candidates for hemiablation based on consensus recommendations. Improved selection criteria and further investigative tools are required to improve patient selection for hemiablation.
我们评估了多参数磁共振成像（mpMRI）与经会阴模板引导穿刺活检（TTMB）相结合来确定男性进行聚焦治疗（FT）（半消融）的适用性，并将其与根治性前列腺切除术（RP）标本的组织学结果进行比较。
本研究分析了2017年5月至2021年6月在单一三级中心接受mpMRI、TTMB和RP的120名男性。半消融适用性标准为单侧低至中风险前列腺癌（最大限于国际泌尿病理学会（ISUP）3级组且前列腺特异性抗原（PSA）<20 ng/mL）以及临床分期≤T2。mpMRI上非器官局限性疾病的证据或对侧前列腺影像报告和数据系统（PI-RADS）v2评分≥4被归类为不适合半消融。RP时具有临床意义的癌症定义为以下任何一种情况：（1）ISUP 1级组且肿瘤体积≥1.3 mL；（2）ISUP≥2级组；或（3）存在晚期（≥pT3）。
在这120名男性中，将52名符合半消融选择标准的男性数据与最终RP结果进行比较。在这52名男性中，42名（80.7%）在RP时可被认为适合半消融。mpMRI和TTMB在预测FT适用性方面的敏感性、特异性和准确性分别为80.7%、85.1%和82.5%。mpMRI和TTMB未检测到对侧显著癌症的发生率为10例（19.2%）。6例有双侧显著癌症，4例有小体积的ISUP≥2级组癌症。
基于共识建议，mpMRI和TTMB相结合可显著改善对半消融潜在候选者的预测。需要改进选择标准和进一步的研究工具以改善半消融患者的选择。
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