Fakunle Mary O, Cowan Janet E, Washington Samuel L, Shinohara Katsuto, Nguyen Hao G, Carroll Peter R
Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
J Urol. 2025 Jan;213(1):34-39. doi: 10.1097/JU.0000000000004265. Epub 2024 Oct 9.
Serial biopsy is a mainstay for patients on active surveillance (AS) for prostate cancer. multiparametric MRI targeting has become a standard. It is unclear whether targeted biopsy alone reliably identifies the dominant lesion, thereby obviating the need for systematic sampling.
Participants enrolled in AS with early-stage prostate cancer (PSA <20, cT1-2, GG1-2) and underwent 2+ systematic biopsy sessions with or without magnetic resonance (MR)-targeted sampling. The findings for dominant Gleason Grade Group (GG) and tumor localization were assessed.
Among 821 men who underwent MR fusion biopsies, 82% were diagnosed with GG1 and 18% with GG2. Sixty-two percent had their first MR fusion biopsy as diagnostic or confirmatory. Across all fusion biopsies, MRI-targeted detection of GG and/or tumor location overlapped with systematic sampling for 95% of cases. For 5% of cases, systematic biopsy was unique in detecting GG and location outside the target. Most unique lesions detected outside the target had marginally aggressive features: 73% GG2 of low-volume and favorable histologic subtypes.
In men with MR fusion biopsies, targeting alone identified the dominant GG and location most of the time (95%); 25% of dominant lesions were contiguous to the target, suggesting that better sampling of the target improves detection. The remaining 5% of men had higher-grade, low-volume disease outside the targeted lesion, of which only 2% had aggressive risk features. MR fusion targeting, without systematic sampling, may be sufficient to monitor men on AS. Few high-risk cancers are missed, all of limited volume and favorable histology.
对于接受前列腺癌主动监测（AS）的患者，系列活检是主要手段。多参数MRI靶向活检已成为标准方法。目前尚不清楚单纯靶向活检能否可靠地识别主要病灶，从而无需进行系统采样。
纳入接受AS的早期前列腺癌患者（PSA<20，cT1-2，GG1-2），并接受2次及以上系统活检，活检过程中可选择进行或不进行磁共振（MR）靶向采样。评估主要Gleason分级组（GG）和肿瘤定位的结果表现。
在821例行MR融合活检的男性患者中，82%被诊断为GG1，18%为GG2。62%的患者将首次MR融合活检作为诊断或确诊检查。在所有融合活检中，MRI靶向检测到的GG和/或肿瘤位置与系统采样在95%的病例中存在重叠。在5%的病例中，系统活检在检测GG和靶外位置方面具有独特性。在靶外检测到的大多数独特病灶具有轻度侵袭性特征：73%为低体积且组织学亚型良好的GG2。
在接受MR融合活检的男性患者中，单纯靶向活检在大多数情况下（95%）可识别主要GG和位置；25%的主要病灶与靶区相邻，这表明对靶区进行更好的采样可提高检测率。其余5%的男性患者在靶向病灶外存在高分级、低体积疾病，其中只有2%具有侵袭性风险特征。不进行系统采样的MR融合靶向活检可能足以对接受AS的男性患者进行监测。很少会遗漏高风险癌症，且所有遗漏的癌症体积均有限且组织学表现良好。
