Malewski Wojciech, Milecki Tomasz, Szempliński Stanisław, Tayara Omar, Kuncman Łukasz, Kryst Piotr, Nyk Łukasz
Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland.
Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland.
J Clin Med. 2023 Aug 28;12(17):5612. doi: 10.3390/jcm12175612.
Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically significant prostate cancer (csPC) detection in TB. Potentially, omitting SB in the case of PIRADS 5 may have a marginal impact on the csPC detection rate. The aim of this study was to determine whether SB can be avoided in the case of PIRADS 5 and to identify potential factors allowing for performing TB only. This cohort study involved = 225 patients with PIRADS 5 on mpMRI (PIRADS 2.0/2.1) who underwent transperineal or transrectal combined biopsy (CB). CsPC was diagnosed in 51.6% ( = 116/225) of cases. TB and SB resulted in the detection of csPC in 48% ( = 108/225) and 20.4% ( = 46/225) of cases, respectively (TB vs. SB, < 0.001). When the TB was positive, SB detected csPC in = 38 of the cases (38/108 = 35%). SB added to TB significantly improved csPC detection in 6.9% of cases in absolute terms ( = 8/116) (TB vs. CB, = 0.008). The multivariate regression model proved that the significant predictors of csPC detection via SB were the densities of the prostate-specific antigen-PSAD > 0.17 ng/mL (OR = 4.038, 95%CI: 1.568-10.398); primary biopsy setting (OR = 2.818, 95%CI: 1.334-5.952); and abnormal digital rectal examination (DRE) (OR = 2.746, 95%CI: 1.328-5.678). In a primary biopsy setting ( = 103), SB detected 10% ( = 6/60) of the additional cases of csPC ( = 0.031), while in a repeat biopsy setting ( = 122), SB detected 3.5% ( = 2/56) of the additional cases of csPC ( = 0.5). In the case of PSAD > 0.17 ng/mL ( = 151), SB detected 7.4% ( = 7/95) of additional cases of csPC ( = 0.016), while in the case of PSAD < 0.17 ng/mL ( = 74), SB detected 4.8% ( = 1/21) of the additional cases of csPC ( = 1.0). The omission of SB had an impact on the csPC diagnosis rate in patients with PIRADS 5 score lesions. Patients who have already undergone prostate biopsy and those with low PSAD are at a lower risk of missing csPC when SB is avoided. However, performing TB only may result in missing other csPC foci located outside the index lesion, which can alter treatment decisions.
在多参数磁共振成像（mpMRI）结果呈阳性的情况下，将系统活检（SB）与靶向活检（TB）相结合仍存在争议。前列腺影像报告和数据系统（PIRADS）评分为5表明在TB中检测到临床显著前列腺癌（csPC）的可能性最高。在PIRADS 5的情况下省略SB可能对csPC检测率产生轻微影响。本研究的目的是确定在PIRADS 5的情况下是否可以避免SB，并确定仅进行TB的潜在因素。这项队列研究纳入了225例mpMRI（PIRADS 2.0/2.1）评分为5的患者，他们接受了经会阴或经直肠联合活检（CB）。51.6%（116/225）的病例被诊断为csPC。TB和SB分别在48%（108/225）和20.4%（46/225）的病例中检测到csPC（TB与SB相比，P<0.001）。当TB为阳性时，SB在38例病例中检测到csPC（38/108 = 35%）。SB加至TB后，绝对而言，在6.9%的病例中（8/116）显著提高了csPC检测率（TB与CB相比，P = 0.008）。多变量回归模型证明，通过SB检测到csPC的显著预测因素是前列腺特异性抗原密度-PSAD>0.17 ng/mL（OR = 4.038，95%CI：1.568 - 10.398）；初次活检情况（OR = 2.818，95%CI：1.334 - 5.952）；以及直肠指检（DRE）异常（OR = 2.746，95%CI：1.328 - 5.678）。在初次活检情况下（103例），SB在另外10%（6/60）的csPC病例中检测到病变（P = 0.031），而在重复活检情况下（122例），SB在另外3.5%（2/56）的csPC病例中检测到病变（P = 0.5）。在PSAD>0.17 ng/mL的情况下（151例），SB在另外7.4%（7/95）的csPC病例中检测到病变（P = 0.016），而在PSAD<0.17 ng/mL的情况下（74例），SB在另外4.8%（1/21）的csPC病例中检测到病变（P = 1.0）。省略SB对PIRADS 5评分病变患者的csPC诊断率有影响。已经接受过前列腺活检的患者以及PSAD较低的患者在避免SB时错过csPC的风险较低。然而，仅进行TB可能会遗漏位于索引病变之外的其他csPC病灶，这可能会改变治疗决策。
