Chappidi Meera R, Newcomb Lisa F, Zheng Yingye, Liu Menghan, Schenk Jeannette M, Zhu Kehao, de la Calle Claire M, Brooks James D, Carroll Peter R, Dash Atreya, Filson Christopher P, Gleave Martin E, Liss Michael A, Martin Frances, McKenney Jesse K, Morgan Todd M, Wagner Andrew A, Nelson Peter S, Lin Daniel W
Department of Urology, University of Washington, Seattle, Washington.
Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington.
J Urol. 2025 Sep;214(3):251-258. doi: 10.1097/JU.0000000000004592. Epub 2025 Apr 30.
No clear guidelines exist regarding MRI use after confirmatory biopsy during active surveillance. Our objective was to evaluate MRI performance after confirmatory biopsy in patients with vs without prior MRI-informed biopsy.
Patients in the Canary Prostate Active Surveillance Study with Gleason Grade Group (GG) 1 disease undergoing MRI-informed Biopsy 2, defined as second surveillance biopsy after diagnosis, were separated into prior vs no prior MRI-informed biopsy groups. Primary outcome was reclassification (≥GG2) at MRI-informed Biopsy 2. Reclassification rates and location (systematic cores, targeted cores, both) were compared between groups. Univariable and multivariable logistic regression identified predictors of reclassification.
Patients with (n = 101) vs without (n = 103) prior MRI-informed biopsy had lower reclassification rates at Biopsy 2 (21% vs 36%, = .017) and lower GG at reclassification (95% vs 73% of reclassifications to GG2, = .039). In multivariable modeling, Prostate Imaging Reporting and Data System 4 or 5 lesion at MRI-informed Biopsy 2 was associated with increased odds of reclassification (odds ratio = 2.04, 95% CI [1.04-4.05]). The negative predictive value of MRI at Biopsy 2 was 87% (95% CI [78-96]) and 73% (95% CI [61-85]) in with vs without prior MRI groups. Reclassification location was identified by targeted cores only in 36% vs 19% of patients with vs without prior MRI ( = .4). Reclassification location was identified by systematic cores only in 36% vs 58% of patients with vs without prior MRI ( = .4).
These results support MRI use at Biopsy 2 and suggest negative surveillance MRI should not replace Biopsy 2. Both targeted and systematic cores should be taken at Biopsy 2 in patients with and without prior MRI on active surveillance.
对于主动监测期间确诊性活检后的MRI使用，目前尚无明确的指导方针。我们的目的是评估在有或没有先前MRI引导活检的患者中，确诊性活检后的MRI表现。
参加金丝雀前列腺主动监测研究且格里森分级组（GG）为1级疾病的患者，接受MRI引导活检2（定义为诊断后的第二次监测活检），被分为有或没有先前MRI引导活检组。主要结局是在MRI引导活检2时重新分级（≥GG2）。比较两组之间的重新分级率和位置（系统穿刺组织条、靶向穿刺组织条或两者皆有）。单变量和多变量逻辑回归确定重新分级的预测因素。
有（n = 101）与没有（n = 103）先前MRI引导活检的患者在活检2时的重新分级率较低（21%对36%，P = 0.017），重新分级时的GG较低（重新分级为GG2的患者中，95%对73%，P = 0.039）。在多变量模型中，MRI引导活检2时前列腺影像报告和数据系统4或5级病变与重新分级几率增加相关（优势比 = 2.04，95%可信区间[1.04 - 4.05]）。在有与没有先前MRI组中，活检2时MRI的阴性预测值分别为87%（95%可信区间[78 - 96]）和73%（95%可信区间[61 - 85]）。仅通过靶向穿刺组织条确定重新分级位置的患者比例，有先前MRI组与没有先前MRI组分别为36%对19%（P = 0.4）。仅通过系统穿刺组织条确定重新分级位置的患者比例，有先前MRI组与没有先前MRI组分别为36%对58%（P = 0.4）。
这些结果支持在活检2时使用MRI，并表明阴性监测MRI不应取代活检2。对于接受主动监测且有或没有先前MRI的患者，活检2时应同时采集靶向和系统穿刺组织条。
