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.
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.