Bennett Richard, Li Eric V, Ho Austin Y, Aguiar Jonathan, Mahenthiran Ashorne K, Suk-Ouichai Chalairat, Kumar Sai K, Neill Clayton, Schaeffer Edward M, Jawahar Anugayathri, Patel Hiten D, Ross Ashley E
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Eur Urol Oncol. 2024 Dec;7(6):1179-1182. doi: 10.1016/j.euo.2024.04.015. Epub 2024 May 11.
The National Comprehensive Cancer Network (NCCN) very low risk (VLR) category for prostate cancer (PCa) represents clinically insignificant disease, and detection of VLR PCa contributes to overdiagnosis. Greater use of magnetic resonance imaging (MRI) and biomarkers before patient selection for prostate biopsy (PBx) reduces unnecessary biopsies and may reduce the diagnosis of clinically insignificant PCa. We tested a hypothesis that the proportion of VLR diagnoses has decreased with greater use of MRI-informed PBx using data from our 11-hospital system. From 2018 to 2023, 351/3197 (11%) men diagnosed with PCa met the NCCN VLR criteria. The proportion of VLR diagnoses did not change from 2018 to 2023 (p = 0.8) despite an increase in the use of MRI-informed PBx (from 49% to 82%; p < 0.001). Of patients who underwent combined systematic and targeted PBx and were diagnosed with VLR disease, cancer was found in systematic PBx regions in 79% of cases and in targeted PBx regions in 31% of cases. When performing both systematic and targeted PBx, prebiopsy MRI-based risk calculators could limit VLR diagnosis by 41% using a risk threshold of >5% for Gleason grade group ≥3 PCa to recommend biopsy; the reduction would be 77% if performing targeted PBx only. These findings suggest that VLR disease continues to account for a significant minority of PCa diagnoses and could be limited by targeted PBx and risk stratification calculators. PATIENT SUMMARY: We looked at recent trends for the diagnosis of very low-risk (VLR) prostate cancer. We found that VLR cancer still seems to be frequently diagnosed despite the use of MRI (magnetic resonance imaging) scans before biopsy. The use of risk calculators to identify men who could avoid biopsy and/or biopsy only for lesions that are visible on MRI could reduce the overdiagnosis of VLR prostate cancer.
美国国立综合癌症网络（NCCN）的前列腺癌（PCa）极低风险（VLR）类别代表临床意义不显著的疾病，而VLR PCa的检测会导致过度诊断。在选择患者进行前列腺活检（PBx）之前更多地使用磁共振成像（MRI）和生物标志物可减少不必要的活检，并可能减少临床意义不显著的PCa的诊断。我们使用来自我们11家医院系统的数据检验了一个假设，即随着MRI引导下PBx使用的增加，VLR诊断的比例有所下降。2018年至2023年期间，351/3197（11%）被诊断为PCa的男性符合NCCN的VLR标准。尽管MRI引导下PBx的使用有所增加（从49%增至82%；p<0.001），但2018年至2023年VLR诊断的比例并未改变（p=0.8）。在接受系统性和靶向性联合PBx并被诊断为VLR疾病的患者中，79%的病例在系统性PBx区域发现癌症，31%的病例在靶向性PBx区域发现癌症。在同时进行系统性和靶向性PBx时，基于活检前MRI的风险计算器对于Gleason分级组≥3的PCa使用>5%的风险阈值来推荐活检，可将VLR诊断减少41%；如果仅进行靶向性PBx，减少率将为77%。这些发现表明，VLR疾病在PCa诊断中仍占相当比例，可通过靶向性PBx和风险分层计算器加以限制。
我们研究了极低风险（VLR）前列腺癌诊断的近期趋势。我们发现，尽管在活检前使用了MRI（磁共振成像）扫描，但VLR癌症似乎仍经常被诊断出来。使用风险计算器来识别那些可以避免活检和/或仅对MRI上可见的病变进行活检的男性，可能会减少VLR前列腺癌的过度诊断。
