Bhanji Yasin, Mamawala Mufaddal K, Fletcher Sean A, Landis Patricia, Patel Hiten D, Macura Katarzyna J, Pavlovich Christian P
The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Urol. 2025 Jan;213(1):20-26. doi: 10.1097/JU.0000000000004268. Epub 2024 Oct 2.
Men diagnosed with prostate cancer (PCa) considering active surveillance (AS) are recommended confirmatory biopsy (CBx). Whether this is necessary in the era of MRI-informed biopsies is questionable.
We studied men with Grade Group (GG) 1 PCa at diagnostic biopsy (DBx) considering AS who underwent MRI and CBx (systematic + targeted) within 18 months. Outcomes were grade reclassification to GG ≥ 2 and GG ≥ 3 and reclassification to unfavorable intermediate-risk (UIR) disease. Subset analyses were performed for men with (1) MRI before DBx and (2) MRI after DBx.
Five hundred twenty-two men had GG1 PCa at DBx. At CBx, 20% reclassified to GG ≥ 2, 12% to UIR disease, and 5.6% to GG ≥ 3. Of the 306 with positive MRI (Prostate Imaging Reporting and Data System ≥3), 27% reclassified to GG ≥ 2 and 16% to UIR disease; men with negative MRI experienced these outcomes at rates of 9.2% and 5.5%, respectively. There were no differences in reclassification outcomes based on MRI timing (group A vs B), and neither PSA density nor prostate volume added to MRI information. In men with MRI targets, approximately one-third of GG 2 reclassification events were only captured by systematic biopsy core(s).
Reclassification rates at CBx were high in men with positive MRI, but < 10% for all reclassification outcomes in men with negative MRI (95% CI, 5.8%-14% for GG 2; 95% CI, 2.9%-10% for UIR; 95% CI, 0.8%-5.3% for GG 3). Our data support systematic + targeted CBx for men with positive MRI considering AS, whereas men with GG1 cancer and negative MRI should be able to defer CBx.
对于考虑进行主动监测（AS）的前列腺癌（PCa）男性患者，建议进行确诊性活检（CBx）。在MRI引导活检的时代，这是否必要尚存在疑问。
我们研究了在诊断性活检（DBx）时被诊断为1级组（GG）前列腺癌且考虑进行AS的男性患者，这些患者在18个月内接受了MRI和CBx（系统活检+靶向活检）。观察指标为分级重新分类为GG≥2级和GG≥3级以及重新分类为不良中危（UIR）疾病。对以下两类男性患者进行了亚组分析：（1）在DBx之前进行MRI检查的患者；（2）在DBx之后进行MRI检查的患者。
522名男性患者在DBx时被诊断为GG1前列腺癌。在CBx时，20%的患者重新分类为GG≥2级，12%的患者重新分类为UIR疾病，5.6%的患者重新分类为GG≥3级。在306名MRI检查结果为阳性（前列腺影像报告和数据系统≥3）的患者中，27%的患者重新分类为GG≥2级，16%的患者重新分类为UIR疾病；MRI检查结果为阴性的患者出现这些结果的比例分别为9.2%和5.5%。基于MRI检查时间（A组与B组）的重新分类结果没有差异，PSA密度和前列腺体积也未增加MRI提供的信息。在有MRI靶向活检的患者中，约三分之一的GG 2级重新分类事件仅通过系统活检组织芯被发现。
MRI检查结果为阳性的男性患者在CBx时的重新分类率较高，但MRI检查结果为阴性的男性患者所有重新分类结果的比例均<10%（GG 2级的95%置信区间为5.8%-14%；UIR的95%置信区间为2.9%-10%；GG 3级的95%置信区间为0.8%-5.3%）。我们的数据支持对考虑进行AS的MRI检查结果为阳性的男性患者进行系统活检+靶向活检，而GG1级癌症且MRI检查结果为阴性的男性患者应能够推迟进行CBx。
