Petov Vladislav, Badyan Konstantin, Gredzhev Vitaliy, Khalidis Elina, Danilov Sergey, Ermolaev Anton, Redkin Vladimir, Chernov Yaroslav, Chinenov Denis, Ganzha Timur, Rzayev Ramin, Timofeeva Ekaterina, Fokin Igor, Enikeev Michael, Krupinov German, Aboyan Igor, Amosov Alexander
Institute for Urology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya St. 2-1, 119435, Moscow, Russia.
SBI of the Rostov Region Clinical and Diagnostic Center Zdorovie, Rostov-On-Don, Russia.
Int Urol Nephrol. 2025 Aug 20. doi: 10.1007/s11255-025-04736-3.
Three MR-targeted biopsy (MR-TB) techniques-software fusion (FUS-TB), cognitive (COG-TB), and in-bore (IB-TB)-are considered comparable by EAU guidelines, although recommendations remain weak. This study aimed to compare detection rates of clinically significant (csPCa), insignificant (cisPCa), and overall prostate cancer (PCa).
This prospective, non-randomized, controlled bicentric study (2019-2024) included biopsy-naïve and previously negative biopsy patients with suspected PCa (PSA ≥ 2 ng/mL, TRUS lesion, positive DRE and PI-RADSv2.1 score ≥ 3). FUS-TB was performed transperineally (3-5 cores) with template mapping biopsy (TPMB; > 20 cores), while COG-TB and IB-TB were performed transrectally (3-5 and 2-3 cores, respectively). COG-TB was combined with standard biopsy (TRUS-GB; 8-12 cores). CsPCa was defined as ISUP grade group ≥ 2.
In total, 481 patients were enrolled: 334 underwent FUS-TB + TPMB, 102-COG-TB + TRUS-GB, and 45-IB-TB. PCa detection was similar among groups: FUS-TB (43.4%), COG-TB (42.1%), and IB-TB (40.0%) (p = 0.89). CsPCa detection was also comparable: 23.1%, 30.3%, and 35.5%, respectively (p = 0.09). Subgroup analysis by PI-RADS and multivariable logistic regression confirmed no significant differences in csPCa detection. IB-TB yielded the lowest cisPCa detection (4.4%, p < 0.01). Adding systematic biopsy to FUS-TB and COG-TB resulted in non-significant increases in csPCa detection (+ 6.6%, p = 0.054; + 4.0%, p = 0.55). There were not considerable differences in positive core proportion (p = 0.76), maximum cancer core length (MCCL) (p = 0.08), or ISUP concordance (p = 0.2).
MR-TB techniques demonstrate comparable csPCa detection after adjustment. IB-TB may reduce overdiagnosis due to lower cisPCa detection rates. Systematic biopsy provides limited additional value, but all results should be interpreted with caution given the study's design.
欧洲泌尿外科学会（EAU）指南认为，三种磁共振靶向活检（MR-TB）技术——软件融合活检（FUS-TB）、认知活检（COG-TB）和腔内活检（IB-TB）具有可比性，尽管相关推荐力度仍较弱。本研究旨在比较具有临床意义的前列腺癌（csPCa）、无临床意义的前列腺癌（cisPCa）和总体前列腺癌（PCa）的检出率。
这项前瞻性、非随机、对照的双中心研究（2019 - 2024年）纳入了初次活检或既往活检阴性且疑似前列腺癌的患者（前列腺特异性抗原[PSA]≥2 ng/mL、经直肠超声[TRUS]发现病变、直肠指检阳性且前列腺影像报告和数据系统[PI-RADS]v2.1评分≥3）。FUS-TB经会阴进行（3 - 5针），同时进行模板引导活检（TPMB；>20针），而COG-TB和IB-TB经直肠进行（分别为3 - 5针和2 - 3针）。COG-TB联合标准活检（TRUS-GB；8 - 12针）。CsPCa定义为国际泌尿病理学会（ISUP）分级组≥2级。
共纳入481例患者：334例接受FUS-TB + TPMB，102例接受COG-TB + TRUS-GB，45例接受IB-TB。各组间前列腺癌检出率相似：FUS-TB为43.4%，COG-TB为42.1%，IB-TB为40.0%（p = 0.89）。CsPCa检出率也具有可比性：分别为23.1%、30.3%和35.5%（p = 0.09）。根据PI-RADS进行的亚组分析和多变量逻辑回归证实，CsPCa检出率无显著差异。IB-TB的cisPCa检出率最低（4.4%，p < 0.01）。在FUS-TB和COG-TB基础上增加系统活检，CsPCa检出率虽有增加但无统计学意义（分别增加6.6%，p = 0.054；增加4.0%，p = 0.55）。阳性针芯比例（p = 0.76）、最大癌针芯长度（MCCL）（p = 0.08）或ISUP一致性（p = 0.2）方面无显著差异。
调整后，MR-TB技术在CsPCa检出方面表现出可比性。IB-TB可能因较低的cisPCa检出率而减少过度诊断。系统活检提供的额外价值有限，但鉴于本研究的设计，所有结果都应谨慎解读。
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