Milecki Tomasz, Malewski Wojciech, Barnaś Anna, Tayara Omar, Antczak Andrzej, Kryst Piotr, Nyk Łukasz
Department of Urology, Poznan University of Medical Sciences, Poland.
Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Cent European J Urol. 2024;77(3):418-423. doi: 10.5173/ceju.2024.95.R1. Epub 2024 Oct 29.
Active surveillance (AS) is an option for management of low-risk and selected intermediate prostate cancer (PC) patients. Pathological progression confirmed on prostate biopsy (PB) is the most common reason for transitioning to radical treatment. The role and timing of repeat PB during AS is a topic of ongoing debate.The aim of the study was to determine the detection rate of clinically significant PC (csPC) during AS protocol by transperineal computer fusion PB in low-risk PC patients enrolled based on results of transrectal systematic PB, and to identify predictors that may impact csPC detection.
The study involved 95 patients with low-risk PC enrolled in AS, who underwent confirmatory or follow-up PB, proceeded by mpMRI.
The reclassification rate to csPC was 38.9% and 43.9% for confirmatory and follow-up biopsies, respectively. Patients with csPC differed significantly from those without csPC in the following parameters: prostate-specific antigen (PSA) 10.5 ng/ml vs 7.3 ng/ml (p = 0.029), PSA density (PSAD) 0.27 ng/ml vs 0.18 ng/ml (p = 0.006), age - 68 years vs 66.5 years (p = 0.024), lesion size 16 mm vs 14 mm (p = 0.042), and PIRADS score (p = 0.004). Multivariable regression models showed that PIRADS score each one-category increase hazard ratio (HR) - 3.615 (1.599-8.172), PSAD >0.20 ng/ml; HR - 2.760 (1.065-7.149) and age; HR - 1.085 (1.011-1.164) were independent factors increasing the probability of csPC detection in PB.
Confirmatory and repeat transperineal PB detect a significant rate of csPC in low-risk PC patients on AS. Higher PIRADS score and PSAD >0.20 ng/ml increase the csPC detection rates during AS and should prompt immediate PB.
主动监测（AS）是低风险和部分中危前列腺癌（PC）患者的一种治疗选择。前列腺穿刺活检（PB）确诊的病理进展是转为根治性治疗的最常见原因。AS期间重复PB的作用和时机是一个仍在争论的话题。本研究的目的是通过经会阴计算机融合PB确定基于经直肠系统PB结果入组的低危PC患者在AS方案期间临床显著前列腺癌（csPC）的检出率，并识别可能影响csPC检出的预测因素。
本研究纳入了95例接受AS的低危PC患者，他们接受了确认性或随访PB，随后进行了多参数磁共振成像（mpMRI）。
确认性活检和随访活检中csPC的重新分类率分别为38.9%和43.9%。csPC患者与无csPC患者在以下参数上存在显著差异：前列腺特异性抗原（PSA）10.5 ng/ml对7.3 ng/ml（p = 0.029）、PSA密度（PSAD）0.27 ng/ml对0.18 ng/ml（p = 0.006）、年龄68岁对66.5岁（p = 0.024）、病灶大小16 mm对14 mm（p = 0.042）以及前列腺影像报告和数据系统（PIRADS）评分（p = 0.004）。多变量回归模型显示，PIRADS评分每增加一个类别，风险比（HR）为3.615（1.599 - 8.172）、PSAD>0.20 ng/ml时HR为2.760（1.065 - 7.149）以及年龄每增加一岁HR为1.085（1.011 - 1.164）是PB中增加csPC检出概率的独立因素。
确认性和重复性经会阴PB在接受AS的低危PC患者中可检测到显著比例的csPC。较高的PIRADS评分和PSAD>0.20 ng/ml会增加AS期间csPC的检出率，应促使立即进行PB。
