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Abstract：
OBJECTIVE: Prostate multiparametric MRI (mpMRI) with subsequent targeted biopsy of suspicious lesions has a critical role in the diagnostic workup of prostate cancer. The objective was to evaluate the diagnostic accuracy of systematic biopsies, targeted biopsies, and the combination of both in prostate cancer detection.
METHODS: From January 1, 2013 to June 1, 2022, biopsy-naïve and prior biopsy-negative patients who underwent both systematic and targeted biopsies were included. MRIs were evaluated according to PI-RADS with biopsy threshold set at PI-RADS ≥3. Systematic biopsies consisted of 8-12 cores, based on prostate volume. Overall prostate cancer and clinically significant cancer (Gleason Score ≥3 + 4) detection rates were stratified based on PI-RADS and location within the prostate, and compared between biopsy types using McNemar test.
RESULTS: Among 867 patients, 615 had prostate cancer, with 434 clinically significant cases. Overall detection rates were: PI-RADS 3 48%, PI-RADS 4 72%, and PI-RADS 5 90%. Detection rates for clinically significant cancer were 21%, 53%, and 72%, respectively. The combination of biopsy methods was most accurate in detecting clinically significant prostate cancer (P < .001). Targeted biopsies alone detected more clinically significant prostate cancer than systematic biopsies alone (43.1% vs 40.3%, P = .046). For posterior PI-RADS 5 lesions, no statistically significant difference was found between all biopsy methods.
CONCLUSIONS: In the detection of clinically significant prostate cancer, the combination of systematic and targeted biopsies proves most effective. Targeted biopsies rarely missed significant cancer for posterior PI-RADS 5 lesions, suggesting systematic biopsies could be reserved for instances where targeted biopsy results are negative.
CONCLUSIONS: This study emphasizes on the efficacy of mpMRI and targeted biopsies in suspected prostate cancer in real-world clinical context. For PI-RADS 5 lesions, systematic biopsies provide limited clinical benefit and may only be necessary when targeted biopsy results are negative.
METHODS: From January 1, 2013 to June 1, 2022, biopsy-naïve and prior biopsy-negative patients who underwent both systematic and targeted biopsies were included. MRIs were evaluated according to PI-RADS with biopsy threshold set at PI-RADS ≥3. Systematic biopsies consisted of 8-12 cores, based on prostate volume. Overall prostate cancer and clinically significant cancer (Gleason Score ≥3 + 4) detection rates were stratified based on PI-RADS and location within the prostate, and compared between biopsy types using McNemar test.
RESULTS: Among 867 patients, 615 had prostate cancer, with 434 clinically significant cases. Overall detection rates were: PI-RADS 3 48%, PI-RADS 4 72%, and PI-RADS 5 90%. Detection rates for clinically significant cancer were 21%, 53%, and 72%, respectively. The combination of biopsy methods was most accurate in detecting clinically significant prostate cancer (P < .001). Targeted biopsies alone detected more clinically significant prostate cancer than systematic biopsies alone (43.1% vs 40.3%, P = .046). For posterior PI-RADS 5 lesions, no statistically significant difference was found between all biopsy methods.
CONCLUSIONS: In the detection of clinically significant prostate cancer, the combination of systematic and targeted biopsies proves most effective. Targeted biopsies rarely missed significant cancer for posterior PI-RADS 5 lesions, suggesting systematic biopsies could be reserved for instances where targeted biopsy results are negative.
CONCLUSIONS: This study emphasizes on the efficacy of mpMRI and targeted biopsies in suspected prostate cancer in real-world clinical context. For PI-RADS 5 lesions, systematic biopsies provide limited clinical benefit and may only be necessary when targeted biopsy results are negative.
摘要：
目的：前列腺多参数磁共振成像（mpMRI）以及随后对可疑病变的靶向活检在前列腺癌的诊断检查中具有关键作用。目的是评估系统活检的诊断准确性，有针对性的活检,以及两者在前列腺癌检测中的结合。
方法：从2013年1月1日至2022年1月6日，纳入了接受系统活检和靶向活检的未活检和先前活检阴性患者。根据PI-RADS评估MRI，活检阈值设置为PI-RADS≥3。系统活检由8-12个核心组成，根据前列腺体积.根据PI-RADS和前列腺内的位置对总体前列腺癌和临床显着癌症（格里森评分≥34）的检出率进行分层，并使用McNemar试验比较活检类型。
结果：在867名患者中，615患有前列腺癌，434例具有临床意义。总体检出率为：PI-RADS348%，PI-RADS472%和PI-RADS590%。有临床意义的癌症检出率为21%，53%和72%，分别。活检方法的组合在检测有临床意义的前列腺癌方面最准确（P<0.001）。单独的靶向活检比单独的系统活检检测到更有临床意义的前列腺癌（43.1％对40.3％，P=0.046)。对于后PI-RADS5个病变，所有活检方法之间无统计学差异。
结论：在检测具有临床意义的前列腺癌时，系统和靶向活检的结合被证明是最有效的.靶向活检很少错过严重的癌症后PI-RADS5病变，提示系统活检可用于靶向活检结果阴性的情况.
结论：本研究强调在现实世界的临床背景下，mpMRI和靶向活检对疑似前列腺癌的疗效。对于PI-RADS5个病变，系统活检的临床获益有限,只有在靶向活检结果为阴性时才有必要.
方法：从2013年1月1日至2022年1月6日，纳入了接受系统活检和靶向活检的未活检和先前活检阴性患者。根据PI-RADS评估MRI，活检阈值设置为PI-RADS≥3。系统活检由8-12个核心组成，根据前列腺体积.根据PI-RADS和前列腺内的位置对总体前列腺癌和临床显着癌症（格里森评分≥34）的检出率进行分层，并使用McNemar试验比较活检类型。
结果：在867名患者中，615患有前列腺癌，434例具有临床意义。总体检出率为：PI-RADS348%，PI-RADS472%和PI-RADS590%。有临床意义的癌症检出率为21%，53%和72%，分别。活检方法的组合在检测有临床意义的前列腺癌方面最准确（P<0.001）。单独的靶向活检比单独的系统活检检测到更有临床意义的前列腺癌（43.1％对40.3％，P=0.046)。对于后PI-RADS5个病变，所有活检方法之间无统计学差异。
结论：在检测具有临床意义的前列腺癌时，系统和靶向活检的结合被证明是最有效的.靶向活检很少错过严重的癌症后PI-RADS5病变，提示系统活检可用于靶向活检结果阴性的情况.
结论：本研究强调在现实世界的临床背景下，mpMRI和靶向活检对疑似前列腺癌的疗效。对于PI-RADS5个病变，系统活检的临床获益有限,只有在靶向活检结果为阴性时才有必要.
