Targeted biopsy of the prostate: does this result in improvement in detection of high-grade cancer or the occurrence of the Will Rogers phenomenon?
Targeted biopsy of the prostate: does this result in improvement in detection of high-grade cancer or the occurrence of the Will Rogers phenomenon?
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DOI：
10.1111/bju.14806
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发表时间：
2019-10-01
影响因子：
4.5
通讯作者：
Ahmed, Hashim U.
中科院分区：
文献类型：
--
作者：
Bass, Edward J.;Orczyk, Clement;Ahmed, Hashim U.
目的探讨经直肠活检的Gleason 3 + 4癌患者在接受经会阴磁共振成像（MRI）靶向活检后是否升级，以及这是否对当前的临床实践有意义。患者和方法在这项回顾性分析中，我们检查了在一个三级转诊中心（2012年7月至2016年7月）就诊的107名连续患者，经直肠超声（TRUS）引导系统非靶向活检Gleason评分为3 + 4，然后接受多参数MRI，随后进行MRI靶向经会阴前列腺活检，以进行准确的风险分层和定位。结果患者的平均（sd）年龄为67.0（8.0）岁，他们的中位（四分位数间距）PSA浓度为6.2（4.7-9.6）ng/mL。在107例患者中，84例（78.5%）经直肠系统活检和经会阴MRI靶向活检的Gleason 3 + 4。19例患者（17.8%）升级为Gleason 4 + 3，3例患者（3.0%）升级为Gleason 4 + 4，1例患者（1.0%）升级为Gleason 4 + 5。这些差异具有显著性（P = 0.0006）。同样，23/107例患者（22%）根据其靶向活检具有较高的疾病风险。结论：在男性不可触及的癌症患者中使用靶向活检，最终将五分之一的患者从有利的中度风险疾病升级为不利的中度风险疾病或更糟。这对考虑积极监测或根治性治疗的男性具有重要的临床意义。随着这项技术的广泛采用，我们的风险计算器现在必须使用这些来自靶向活检的数据进行验证。
Objective To investigate whether patients with Gleason 3 + 4 cancer on transrectal biopsy are upgraded after undergoing transperineal magnetic resonance imaging (MRI)-targeted biopsy and whether this has implications for current clinical practice. Patients and Methods In this retrospective analysis we examined 107 consecutive patients presenting at a single tertiary referral centre (July 2012 to July 2016) with prostate cancer of Gleason score 3 + 4 on transrectal ultrasonography (TRUS)-guided systematic non-targeted biopsy who then underwent a multiparametric MRI followed by MRI-targeted transperineal prostate biopsy for accurate risk stratification and localization. Results The patients' mean (sd) age was 67.0 (8.0) years, and they had a median (interquartile range) PSA concentration of 6.2 (4.7-9.6) ng/mL. Of the 107 patients, 84 (78.5%) had Gleason 3 + 4 on both transrectal systematic biopsy and transperineal MRI-targeted biopsy. Nineteen patients (17.8%) were upgraded to Gleason 4 + 3, three patients (3.0%) to Gleason 4 + 4 and one patient (1.0%) to Gleason 4 + 5. These differences were significant (P = 0.0006). Likewise, 23/107 patients (22%) had higher-risk disease based on their targeted biopsies. Conclusion The use of targeted biopsy in men with impalpable cancer, ultimately upgraded one in five patients from favourable-intermediate- to unfavourable-intermediate-risk disease or worse. This has significant clinical implications for men considering active surveillance or radical treatment. Our risk calculators must now be validated using these data from targeted biopsy as the technique becomes widely adopted.