Yusim Igor, Mazor Elad, Frumkin Einat, Hefer Ben, Li Sveta, Novack Victor, Mabjeesh Nicola J
Department of Urology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
Soroka Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
Front Oncol. 2024 Dec 11;14:1496479. doi: 10.3389/fonc.2024.1496479. eCollection 2024.
The prostate biopsy (PB) results should be concordant with prostatectomy histopathology to avoid overestimating or underestimating the disease, leading to inappropriate or undertreatment of prostate cancer (PCa) patients. Since the introduction of multiparametric Magnetic Resonance Imaging (mpMRI) in the diagnostic pathway of PCa, most studies have shown that MRI/Ultrasound fusion-guided (MRI-fusion) PB improves concordance with histopathology of radical prostatectomy specimens. This study aimed to evaluate the improvement in concordance of prostatectomy specimens with PB histopathology obtained using the MRI-fusion approach compared with the 12-core TRUS-Bx and to identify the variables influencing this.
The study included 218 men who were diagnosed with PCa by PB and underwent radical prostatectomy between 2016 and 2023. The patients were grouped based on the biopsy method: 115 underwent TRUS-Bx, and 103 underwent MRI-fusion PB. The histopathological grading of these biopsy approaches was compared with that of radical prostatectomy specimens. Multivariate logistic regression analyses were conducted to evaluate the impact of various criteria on histopathological concordance.
In patients with unfavorable intermediate- and high-risk PCa, MRI-fusion PB showed significantly better concordance with prostatectomy histopathology than TRUS-Bx (73.1% vs. 42.9%, p = 0.018). MRI-fusion PB had a significantly lower downgrading of prostatectomy histopathology than TRUS-Bx in all grade categories. The number of cancer-involved regions of the prostate is an independent predictor for concordance (OR = 1.24, 95%CI = 1.04-1.52, p = 0.02) and downgrading (OR = 0.46, 95%CI = 0.24-0.83, p = 0.01).
Using an MRI-fusion PB improves histopathological concordance in patients with unfavorable intermediate and high-risk PCa. It reduces the downgrading rate of prostatectomy histopathology compared with TRUS-Bx in all grade categories. The number of cancer-involved regions is an independent predictor of the concordance between biopsy and final histopathology after prostatectomy and post-prostatectomy histopathology downgrading. Our findings could assist in selecting PCa patients for AS and focal treatment based on the histopathology obtained from the MRI-fusion PB.
前列腺穿刺活检（PB）结果应与前列腺切除术后的组织病理学结果一致，以避免高估或低估疾病，导致前列腺癌（PCa）患者接受不适当或不充分的治疗。自从多参数磁共振成像（mpMRI）引入PCa诊断途径以来，大多数研究表明，MRI/超声融合引导（MRI融合）PB可提高与根治性前列腺切除标本组织病理学的一致性。本研究旨在评估与12针经直肠超声引导下穿刺活检（TRUS-Bx）相比，使用MRI融合方法获得的前列腺切除标本与PB组织病理学的一致性改善情况，并确定影响这一情况的变量。
该研究纳入了218名在2016年至2023年间经PB诊断为PCa并接受根治性前列腺切除术的男性。患者根据活检方法分组：115例行TRUS-Bx，103例行MRI融合PB。将这些活检方法的组织病理学分级与根治性前列腺切除标本的分级进行比较。进行多因素逻辑回归分析以评估各种标准对组织病理学一致性的影响。
在中高危PCa患者中，MRI融合PB与前列腺切除术后组织病理学的一致性显著优于TRUS-Bx（73.1%对42.9%，p = 0.018）。在所有分级类别中，MRI融合PB导致前列腺切除术后组织病理学降级的情况显著少于TRUS-Bx。前列腺癌累及区域的数量是一致性（OR = 1.24，95%CI = 1.04 - 1.52，p = 0.02）和降级（OR = 0.46，95%CI = 0.24 - 0.83，p = 0.01）的独立预测因素。
使用MRI融合PB可提高中高危PCa患者的组织病理学一致性。与TRUS-Bx相比，它在所有分级类别中均降低了前列腺切除术后组织病理学的降级率。癌累及区域的数量是前列腺切除术后活检与最终组织病理学及术后组织病理学降级之间一致性的独立预测因素。我们的研究结果有助于根据MRI融合PB获得的组织病理学为PCa患者选择主动监测和局部治疗。
