Nwanze Julum, Teramoto Yuki, Wang Ying, Miyamoto Hiroshi
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center Rochester, NY, USA.
Department of Urology, University of Rochester Medical Center Rochester, NY, USA.
Am J Clin Exp Urol. 2024 Aug 25;12(4):162-172. doi: 10.62347/BODM5001. eCollection 2024.
MRI-targeted biopsy (T-Bx) for which Prostate Imaging Reporting and Data System (PI-RADS) assessment categories are useful has been shown to more accurately detect clinically significant prostate cancer. However, the prognostic significance of the PI-RADS in prostate cancer patients needs further investigation. In the present study, we compared radical prostatectomy findings and postoperative oncologic outcomes in men with prostate cancer initially undergoing T-Bx for PI-RADS 3 vs. 4 vs. 5 lesions.
We assessed consecutive patients undergoing T-Bx with concurrent systematic biopsy (S-Bx), followed by radical prostatectomy. Within our Surgical Pathology database, we identified a total of 207 men where prostatic adenocarcinoma was detected on either S-Bx or T-Bx, or both.
Prostate cancer was detected on S-Bx only (n = 32; 15%), T-Bx only (n = 39; 19%), or both S-Bx and T-Bx (n = 136; 66%). These patients had PI-RADS 3 (n = 42; 20%), 4 (n = 86; 42%), or 5 (n = 79; 38%) lesions, while T-Bx detected cancer in 31 (74%) of PI-RADS 3 cases, 72 (84%) of PI-RADS 4 cases, and 72 (91%) of PI-RADS 5 cases. There were no significant differences in any of the clinicopathologic features examined, including tumor grade on biopsy or prostatectomy and pT or pN stage, among the PI-RADS 3 vs. 4 vs. 5 groups, except a significantly higher rate of positive margin and significantly larger tumor volume in PI-RADS 5 cases than in PI-RADS 3 cases. Univariate and multivariable analyses revealed significantly higher risks of biochemical recurrence after prostatectomy in patients with PI-RADS 5 lesion than in those with PI-RADS 3 or 4 lesion. Additionally, compared with respective controls, detection of any grade cancer ( = 0.046) or Grade Group 2 or higher cancer ( = 0.005) on T-Bx was associated with a significantly higher risk of recurrence in patients with PI-RADS 5 lesion, but not in those with PI-RADS 3 or 4 lesion.
PI-RADS 5 lesions were thus found to independently predict a significantly poorer postoperative prognosis. Moreover, the failure of detection of any grade cancer or clinically significant cancer on T-Bx of PI-RADS 5 lesion may particularly indicate favorable outcomes in radical prostatectomy cases.
已证实，前列腺影像报告和数据系统（PI-RADS）评估类别对MRI靶向活检（T-Bx）检测临床意义重大的前列腺癌更为准确。然而，PI-RADS在前列腺癌患者中的预后意义仍需进一步研究。在本研究中，我们比较了最初因PI-RADS 3、4、5类病变接受T-Bx的前列腺癌男性患者的根治性前列腺切除术结果及术后肿瘤学结局。
我们评估了连续接受T-Bx及同步系统活检（S-Bx），随后接受根治性前列腺切除术的患者。在我们的外科病理学数据库中，我们共识别出207名男性，这些男性在S-Bx或T-Bx或两者中均检测到前列腺腺癌。
仅在S-Bx中检测到前列腺癌（n = 32；15%），仅在T-Bx中检测到（n = 39；19%），或在S-Bx和T-Bx中均检测到（n = 136；66%）。这些患者有PI-RADS 3类（n = 42；20%）、4类（n = 86；42%）或5类（n = 79；38%）病变，而T-Bx在PI-RADS 3类病例的31例（74%）、PI-RADS 4类病例的72例（84%）和PI-RADS 5类病例的72例（91%）中检测到癌症。在PI-RADS 3、4、5组之间，所检查的任何临床病理特征，包括活检或前列腺切除术中的肿瘤分级以及pT或pN分期，均无显著差异，但PI-RADS 5类病例的切缘阳性率显著更高，肿瘤体积显著大于PI-RADS 3类病例。单因素和多因素分析显示，PI-RADS 5类病变患者前列腺切除术后生化复发风险显著高于PI-RADS 3或4类病变患者。此外，与各自的对照组相比，T-Bx检测到任何分级癌症（P = 0.046）或2级及以上分级癌症（P = 0.005）与PI-RADS 5类病变患者的复发风险显著更高相关，但与PI-RADS 3或4类病变患者无关。
因此，发现PI-RADS 5类病变可独立预测术后预后显著较差。此外，PI-RADS 5类病变的T-Bx未检测到任何分级癌症或临床意义重大的癌症，这可能特别表明根治性前列腺切除术病例的预后良好。
