Department of Urology, The Fourth Affiliated Hospital of Soochow University (Dushu Lake Hospital Affiliated to Soochow University), No.9 Chongwen Road, Suzhou, 215006, People's Republic of China.
Department of Urology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People's Republic of China.
World J Urol. 2024 Oct 30;42(1):608. doi: 10.1007/s00345-024-05294-6.
The varying malignancy and lethality of different grades of prostate cancer (PCa) highlight the importance of accurate diagnosis. This study aims to evaluate the upgrading of transition zone (TZ) prostate cancer biopsies and identify factors to improve TZ biopsy accuracy.
This retrospective study included 217 patients who underwent laparoscopic radical prostatectomy after 12 + X cores transperineal transrectal ultrasound-magnetic resonance imaging (MRI)-guided targeted prostate biopsy from 2018 to 2021 in our center.
Patients with TZ lesions showed a higher incidence of International Society of Urological Pathology (ISUP) grade upgrading from 1 to higher grade compared to peripheral zone lesions (16.9% vs. 5.0%, p = 0.005). Multivariate analysis confirmed TZ lesions as an independent risk factor (OR: 4.594, 97.5% CI: 1.569-15.238, p = 0.008) for upgrading from 1 to higher. Additionally, the number of positive biopsy cores (OR: 0.586, 97.5% CI: 0.336-0.891, p = 0.029) and anterior TZ lesion location (OR: 10.797, 97.5% CI: 1.503-248.727, p = 0.048) were independent factors for the upgrading in TZ patients.
This study found that PCa lesions located in the TZ, particularly the anterior TZ, have a higher risk of ISUP grade upgrading. This elevated risk arises from the insufficient distribution of biopsy cores around the TZ lesion. The findings underscore the importance of having an adequate number of biopsy cores around the lesion area to improve the accuracy of ISUP grade assessments.
不同分级前列腺癌（PCa）的恶性程度和致死率不同，这突出了准确诊断的重要性。本研究旨在评估移行区（TZ）前列腺癌活检的升级情况，并确定提高 TZ 活检准确性的因素。
本回顾性研究纳入了 2018 年至 2021 年期间在我院接受腹腔镜根治性前列腺切除术的 217 例患者，这些患者在接受手术前均接受了 12+X 芯经会阴经直肠超声-磁共振成像（MRI）引导下靶向前列腺活检。
与外周区病灶相比，TZ 病灶患者的国际泌尿病理学会（ISUP）分级升级（从 1 级升级到更高级）的发生率更高（16.9%比 5.0%，p=0.005）。多变量分析证实 TZ 病灶是从 1 级升级到更高级的独立危险因素（OR：4.594，97.5%CI：1.569-15.238，p=0.008）。此外，阳性活检芯数（OR：0.586，97.5%CI：0.336-0.891，p=0.029）和 TZ 病灶前位位置（OR：10.797，97.5%CI：1.503-248.727，p=0.048）是 TZ 患者升级的独立因素。
本研究发现，TZ 部位的 PCa 病灶，特别是前 TZ 部位，具有更高的 ISUP 分级升级风险。这种风险升高是由于 TZ 病灶周围活检芯分布不足所致。这些发现强调了在病灶区域周围获得足够数量的活检芯以提高 ISUP 分级评估准确性的重要性。
