Ye Bi-Ran, Wang Hui, Zhang Yong-Qing, Lin Guo-Wen, Xu Hua, Hong Zhe, Dai Bo, Wan Fang-Ning
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Fudan University Shanghai Medical College, Shanghai 200032, China.
Asian J Androl. 2025 Jul 1;27(4):488-494. doi: 10.4103/aja202515. Epub 2025 May 2.
The choice of biopsy method is critical in diagnosing prostate cancer (PCa). This retrospective cohort study compared systematic biopsy (SB) or cognitive fusion-targeted biopsy combined with SB (CB) in detecting PCa and clinically significant prostate cancer (csPCa). Data from 2572 men who underwent either SB or CB in Fudan University Shanghai Cancer Center (Shanghai, China) between January 2019 and December 2023 were analyzed. Propensity score matching (PSM) was used to balance baseline characteristics, and detection rates were compared before and after PSM. Subgroup analyses based on prostate-specific antigen (PSA) levels and Prostate Imaging-Reporting and Data System (PI-RADS) scores were performed. Primary and secondary outcomes were the detection rates of PCa and csPCa, respectively. Of 2572 men, 1778 were included in the PSM analysis. Before PSM, CB had higher detection rates for both PCa (62.9% vs 52.4%, odds ratio [OR]: 1.54, P < 0.001) and csPCa (54.9% vs 43.3%, OR: 1.60, P < 0.001) compared to SB. After PSM, CB remained superior in detecting PCa (63.1% vs 47.9%, OR: 1.86, P < 0.001) and csPCa (55.0% vs 38.2%, OR: 1.98, P < 0.001). In patients with PSA 4-12 ng ml -1 (>4 ng ml -1 and ≤12 ng ml -1 , which is also applicable to the following text), CB detected more PCa (59.8% vs 40.7%, OR: 2.17, P < 0.001) and csPCa (48.1% vs 27.7%, OR: 2.42, P < 0.001). CB also showed superior csPCa detection in those with PI-RADS 3 lesions (32.1% vs 18.0%, OR: 2.15, P = 0.038). Overall, CB significantly improves PCa and csPCa detection, especially in patients with PSA 4-12 ng ml -1 or PI-RADS 3 lesions.
活检方法的选择对于前列腺癌（PCa）的诊断至关重要。这项回顾性队列研究比较了系统活检（SB）或认知融合靶向活检联合SB（CB）在检测PCa和临床显著性前列腺癌（csPCa）方面的效果。分析了2019年1月至2023年12月期间在复旦大学附属上海肿瘤医院（中国上海）接受SB或CB的2572名男性的数据。采用倾向评分匹配（PSM）来平衡基线特征，并比较PSM前后的检测率。基于前列腺特异性抗原（PSA）水平和前列腺影像报告和数据系统（PI-RADS）评分进行亚组分析。主要和次要结局分别是PCa和csPCa的检测率。在2572名男性中，1778名纳入PSM分析。在PSM之前，与SB相比，CB对PCa（62.9%对52.4%，优势比[OR]：1.54，P<0.001）和csPCa（54.9%对43.3%，OR：1.60，P<0.001）的检测率更高。在PSM之后，CB在检测PCa（63.1%对47.9%，OR：1.86，P<0.001）和csPCa（55.0%对38.2%，OR：1.98，P<0.001）方面仍然更具优势。在PSA为4 - 12 ng/ml（>4 ng/ml且≤12 ng/ml，以下文本亦适用）的患者中，CB检测到更多的PCa（59.8%对40.7%，OR：2.17，P<0.001）和csPCa（48.1%对27.7%，OR：2.42，P<0.001）。在PI-RADS 3类病变患者中，CB在csPCa检测方面也更具优势（32.1%对18.0%，OR：2.15，P = 0.038）。总体而言，CB显著提高了PCa和csPCa的检测率，尤其是在PSA为4 - 12 ng/ml或PI-RADS 3类病变的患者中。
