Wang Carrie, Trivedi Purvish, Katende Esther, Awasthi Varun, Smith Riley, Putney Ryan, Bondokji Yahya, Park Jong Y, Dhillon Jasreman, Yamoah Kosj
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
Eur J Radiol Open. 2025 Mar 7;14:100642. doi: 10.1016/j.ejro.2025.100642. eCollection 2025 Jun.
Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography.
The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-of-interest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS).
Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment ( = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort ( = .002).
Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.
传统的基于超声的前列腺活检采用经直肠途径对12个核心区域进行系统采样。磁共振成像（MRI）融合活检采用靶向方法，首先通过MRI识别临床上怀疑为前列腺癌（PCa）的感兴趣区域（ROI），然后在超声辅助下进行前列腺活检。
这项单中心机构回顾性队列研究纳入了442名被推荐进行局限性PCa管理的男性。队列A（n = 346）包括接受MRI引导下经直肠超声（TRUS）活检的患者，其中包括标准的12针TRUS活检和同时进行的MRI靶向活检。队列B（n = 96）包括仅接受标准TRUS活检的患者。主要终点是Gleason分级重新分类，定义为队列A中标准TRUS活检和靶向感兴趣区域（ROI）活检之间Gleason评分的变化。次要终点通过分析接受治疗的概率和主动监测（AS）的持续时间来评估ROI活检在减少过度治疗中的作用。
在标准活检中被分类为无肿瘤的男性中，16.9%在随后的ROI活检中显示有Gleason疾病。此外，ROI组接受初次治疗的时间也更长（P = 0.017），因为他们更有可能选择AS（54%）。最后，与非ROI队列相比，ROI组在AS上花费的中位时间更长（P = 0.002）。
在标准TRUS活检中增加多参数MRI（mpMRI）活检可能会提高PCa的检出率。此外，mpMRI可能使患者能够安全地进行AS，从而减少前列腺活检的需求并提高成本效益。
