Koo Michael Jakun, Lee Byunghun, Song Wan, Kang Minyong, Sung Hyun Hwan, Jeong Byong Chang, Seo Seong Il, Jeon Seong Soo, Lee Chung Un, Jeon Hwang Gyun
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Gyeonggi-do, Republic of Korea.
Front Oncol. 2025 Mar 14;14:1403237. doi: 10.3389/fonc.2024.1403237. eCollection 2024.
We investigated the change to definitive treatment in patients under active surveillance (AS) and cancer diagnosis in non-cancerous patients for prostate cancer after confirmatory transperineal template-guided mapping biopsy (TTMB).
A total of 336 patients who underwent TTMB between March 2017 and March 2023 were retrospectively reviewed, with 134 AS patients and 202 non-cancerous patients. All patients were routinely followed up via prostate-specific antigen (PSA) and multiparametric magnetic resonance imaging (mpMRI), and follow-up biopsy was performed when deemed clinically appropriate. Treatment changes in the AS and cancer detection in the non-cancerous group were analyzed. Descriptive statistics were used to analyze the retrospective data, and the Kaplan-Meier analysis was performed to indicate conversion to radical treatment in the AS group, as well as cancer detection in the previously benign non-cancerous group.
One hundred thirty-four patients under the AS protocol were analyzed, of whom 110 (82.1%) maintained AS for 33 months. Nine patients (6.7%) had significant findings in mpMRI [Prostate Imaging-Reporting and Data System (PI-RADS) ≥3] and received radical treatment following target biopsy via transrectal ultrasonography. A total of 115 patients (83.3%) with insignificant findings in mpMRI (PI-RADS 1 or 2 lesions) were followed up via transrectal ultrasound-guided prostate biopsy (17.4%, N = 20), repeat TTMB (6.1%, N = 7), or no additional biopsy (76.5%, N = 88), and from each group, five (25.0%), two (28.5%), and eight (9.1%) patients converted to radical treatment. In the non-cancerous group, five patients (2.5%) were diagnosed with prostate cancer, with PI-RADS ≥ 3 findings via mpMRI, and were confirmed by target biopsy during a mean follow-up period of 25 months, subsequently receiving radical treatment.
TTMB is effective in selecting patients for AS treatment and confirming benign patients and can be used as an effective follow-up modality.
我们研究了在接受主动监测（AS）的患者中确定性治疗的变化情况，以及在经会阴模板引导穿刺活检（TTMB）确诊后非癌患者中前列腺癌的诊断情况。
回顾性分析了2017年3月至2023年3月期间接受TTMB的336例患者，其中134例为AS患者，202例为非癌患者。所有患者均通过前列腺特异性抗原（PSA）和多参数磁共振成像（mpMRI）进行常规随访，并在临床认为合适时进行随访活检。分析了AS组的治疗变化和非癌组的癌症检测情况。使用描述性统计分析回顾性数据，并进行Kaplan-Meier分析以表明AS组转为根治性治疗的情况，以及先前良性非癌组的癌症检测情况。
分析了134例接受AS方案的患者，其中110例（82.1%）维持AS治疗33个月。9例患者（6.7%）在mpMRI上有显著发现[前列腺影像报告和数据系统（PI-RADS）≥3]，并在经直肠超声引导下进行靶向活检后接受了根治性治疗。共有115例在mpMRI上无显著发现（PI-RADS 1或2级病变）的患者通过经直肠超声引导前列腺活检（17.4%，n = 20）、重复TTMB（6.1%，n = 7）或不进行额外活检（76.5%，n = 88）进行随访，每组分别有5例（25.0%）、2例（28.5%）和8例（9.1%）患者转为根治性治疗。在非癌组中，5例患者（2.5%）被诊断为前列腺癌，通过mpMRI发现PI-RADS≥3，并在平均25个月的随访期间经靶向活检确诊，随后接受了根治性治疗。
TTMB在选择AS治疗患者和确认良性患者方面有效，可作为一种有效的随访方式。
