Abstract：
OBJECTIVE: Patients with suspicion of clinically significant prostate cancer (csPC) on multiparametric prostate MRI (mpMRI) but negative or inconclusive MRI/US fusion-guided biopsy (FB) can be challenging in clinical practice. To assess the utility of MRI in-bore biopsy (IB) in patients with discordant imaging and histopathological findings after FB.
METHODS: Consecutive patients with Prostate Imaging Reporting and Data System (PI-RADS) category 4 or 5 on mpMRI at 3T after FB without histologically confirmed csPC who underwent IB between 01/2014 and 05/2022, were retrospectively included. The primary objective was to assess the detection rate of csPC. Secondary objectives were to analyze clinical parameters, MRI parameters, and lesion localization.
RESULTS: In the final cohort of 51 patients, the IB resulted in an overall detection rate of 71% for PC and 47% for csPC. Furthermore, in 55% of cases with initial low-grade PC, the Gleason score was upgraded after IB. CsPC was often detected apical and/or anterior. The detection rate for PC was 58% in PI-RADS category 4 and 94% in PI-RADS category 5 (csPC 39% and 61%, respectively). Patients with csPC had statistically significant smaller prostate volumes, a higher PI-RADS category, a higher prostate-specific antigen density (PSAD), and were older.
CONCLUSIONS: For a relevant proportion of patients with PI-RADS category 4 or 5 and negative or inconclusive findings on previous FB, but with persistent suspicion of csPC, a subsequent IB verified the presence of csPC. Therefore, IB can be a backup in cases of uncertainty.
METHODS: Consecutive patients with Prostate Imaging Reporting and Data System (PI-RADS) category 4 or 5 on mpMRI at 3T after FB without histologically confirmed csPC who underwent IB between 01/2014 and 05/2022, were retrospectively included. The primary objective was to assess the detection rate of csPC. Secondary objectives were to analyze clinical parameters, MRI parameters, and lesion localization.
RESULTS: In the final cohort of 51 patients, the IB resulted in an overall detection rate of 71% for PC and 47% for csPC. Furthermore, in 55% of cases with initial low-grade PC, the Gleason score was upgraded after IB. CsPC was often detected apical and/or anterior. The detection rate for PC was 58% in PI-RADS category 4 and 94% in PI-RADS category 5 (csPC 39% and 61%, respectively). Patients with csPC had statistically significant smaller prostate volumes, a higher PI-RADS category, a higher prostate-specific antigen density (PSAD), and were older.
CONCLUSIONS: For a relevant proportion of patients with PI-RADS category 4 or 5 and negative or inconclusive findings on previous FB, but with persistent suspicion of csPC, a subsequent IB verified the presence of csPC. Therefore, IB can be a backup in cases of uncertainty.
摘要：
目的：在多参数前列腺MRI（mpMRI）上怀疑有临床意义的前列腺癌（csPC）但MRI/US融合引导活检（FB）阴性或不确定的患者在临床实践中可能具有挑战性。评估FB后影像学和组织病理学发现不一致的患者的MRI钻孔活检（IB）的实用性。
方法：回顾性纳入2014年1月至2022年5月5日接受IB治疗的患者，在FB后3T行mpMRI检查，无组织学证实的csPC，行前列腺影像学报告和数据系统（PI-RADS）4级或5级。主要目的是评估csPC的检出率。次要目标是分析临床参数，MRI参数,和病变定位。
结果：在51名患者的最后队列中，IB对PC和csPC的总检出率分别为71%和47%。此外，在55%的初始低级PC案例中，IB后Gleason评分升级。CsPC常被检测到根尖和/或前部。PC的检出率在PI-RADS类别4中为58％，在PI-RADS类别5中为94％（csPC39％和61％，分别)。CSPC患者的前列腺体积较小，具有统计学意义，更高的PI-RADS类别，较高的前列腺特异性抗原密度（PSAD），而且年纪大了.
结论：对于PI-RADS4或5类患者的相关比例，并且先前FB的结果为阴性或不确定，但一直怀疑CSPC,随后的IB验证了csPC的存在。因此,在不确定的情况下,IB可以是备份。
方法：回顾性纳入2014年1月至2022年5月5日接受IB治疗的患者，在FB后3T行mpMRI检查，无组织学证实的csPC，行前列腺影像学报告和数据系统（PI-RADS）4级或5级。主要目的是评估csPC的检出率。次要目标是分析临床参数，MRI参数,和病变定位。
结果：在51名患者的最后队列中，IB对PC和csPC的总检出率分别为71%和47%。此外，在55%的初始低级PC案例中，IB后Gleason评分升级。CsPC常被检测到根尖和/或前部。PC的检出率在PI-RADS类别4中为58％，在PI-RADS类别5中为94％（csPC39％和61％，分别)。CSPC患者的前列腺体积较小，具有统计学意义，更高的PI-RADS类别，较高的前列腺特异性抗原密度（PSAD），而且年纪大了.
结论：对于PI-RADS4或5类患者的相关比例，并且先前FB的结果为阴性或不确定，但一直怀疑CSPC,随后的IB验证了csPC的存在。因此,在不确定的情况下,IB可以是备份。
