Abstract：
OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer (csPCa), and microultrasound (micro-US) shows promise in enhancing detection rates. We compared mpMRI-guided targeted biopsy (MTBx) and micro-US-guided targeted biopsy (micro-US-TBx) in biopsy-naïve patients with discordant lesions at micro-US and mpMRI to detect csPCa (grade group ≥2) and clinically insignificant PCa (ciPCa; grade group 1) and assessed the role of nontargeted systematic biopsy (SBx).
METHODS: We analyzed 178 biopsy-naive men with suspected PCa and discordant lesions at mpMRI and micro-US. All patients underwent mpMRI followed by micro-US, the latter being performed immediately before the biopsy. Imaging findings were interpreted blindly, followed by targeted and SBx. Median age was 63 years (IQR, 57-70), median prostate-specific antigen level was 7 ng/mL (IQR, 5-9 ng/mL), and median prostate volume was 49 cm^3 (IQR, 35-64 cm^3). Overall, 86/178 (48%) patients were diagnosed with PCa, 51/178 (29%) with csPCa.
RESULTS: Micro-USTBx detected csPCa in 36/178 men (20%; 95% CI: 26-46), and MTBx detected csPCa in 28/178 men (16%; 95% CI: 36-50), resulting in a -8% difference (95% CI: -10, 4; P = 0.022) and a relative detection rate of 0.043. Micro-USTBx detected ciPCa in 9/178 men (5%; 95% CI: 3, 15), while MTBx detected ciPCa in 12/178 men (7%; 95% CI: 5, 20), resulting in a -3% difference (95% CI: -2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 (16%) men. mpMRI plus micro-US detected csPCa in 51/178 men, with no additional cases with the addition of SBx. Similarly, MTBx plus micro-USTBx plus SBx detected ciPCa in 35/178 men (20%; 95% CI: 18, 37) compared to 9 (5%) in the micro-US pathway (P = 0.002) and 14/178 (8%; 95% CI: 6, 26) in the mpMRI plus micro-US pathway (P = 0.004).
CONCLUSIONS: In conclusion, a combined micro-US/mpMRI approach could characterize primary disease in biopsy-naïve patients with discordant lesions, potentially avoiding SBx. Further studies are needed to validate our findings and assess micro-US\'s role in reducing unnecessary biopsies.
METHODS: We analyzed 178 biopsy-naive men with suspected PCa and discordant lesions at mpMRI and micro-US. All patients underwent mpMRI followed by micro-US, the latter being performed immediately before the biopsy. Imaging findings were interpreted blindly, followed by targeted and SBx. Median age was 63 years (IQR, 57-70), median prostate-specific antigen level was 7 ng/mL (IQR, 5-9 ng/mL), and median prostate volume was 49 cm^3 (IQR, 35-64 cm^3). Overall, 86/178 (48%) patients were diagnosed with PCa, 51/178 (29%) with csPCa.
RESULTS: Micro-USTBx detected csPCa in 36/178 men (20%; 95% CI: 26-46), and MTBx detected csPCa in 28/178 men (16%; 95% CI: 36-50), resulting in a -8% difference (95% CI: -10, 4; P = 0.022) and a relative detection rate of 0.043. Micro-USTBx detected ciPCa in 9/178 men (5%; 95% CI: 3, 15), while MTBx detected ciPCa in 12/178 men (7%; 95% CI: 5, 20), resulting in a -3% difference (95% CI: -2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 (16%) men. mpMRI plus micro-US detected csPCa in 51/178 men, with no additional cases with the addition of SBx. Similarly, MTBx plus micro-USTBx plus SBx detected ciPCa in 35/178 men (20%; 95% CI: 18, 37) compared to 9 (5%) in the micro-US pathway (P = 0.002) and 14/178 (8%; 95% CI: 6, 26) in the mpMRI plus micro-US pathway (P = 0.004).
CONCLUSIONS: In conclusion, a combined micro-US/mpMRI approach could characterize primary disease in biopsy-naïve patients with discordant lesions, potentially avoiding SBx. Further studies are needed to validate our findings and assess micro-US\'s role in reducing unnecessary biopsies.
摘要：
目的：多参数磁共振成像（mpMRI）提高了对有临床意义的前列腺癌（csPCa）的检测，和微超声（micro-US）在提高检出率方面显示出希望。我们比较了mpMRI引导的靶向活检（MTBx）和micro-US引导的靶向活检（micro-US-TBx）在micro-US和mpMRI不一致病变的未活检患者中，以检测csPCa（等级组≥2）和临床上无意义的PCa（ciPCa；等级组1），并评估了非靶向系统活检（SBx）的作用。
方法：我们在mpMRI和micro-US分析了178例疑似PCa和不一致病变的未接受活检的男性。所有患者都接受了mpMRI，然后是micro-US，后者在活检前立即进行。影像学检查结果被盲目解释，其次是针对性和SBx。中位年龄为63岁(IQR，57-70），中位前列腺特异性抗原水平为7ng/mL(IQR，5-9ng/mL)，前列腺体积中位数为49cm^3(IQR，35-64厘米^3）。总的来说,86/178（48%）患者被诊断为PCa，51/178（29%）与csPCa。
结果：Micro-USTBx在36/178名男性中检测到csPCa（20％；95％CI：26-46），MTBx在28/178名男性中检测到csPCa（16％；95％CI：36-50），结果差异为-8%（95%CI：-10，4；P=0.022），相对检出率为0.043。Micro-USTBx在9/178名男性中检测到ciPCa（5％；95％CI：3，15），而MTBx在12/178名男性中检测到ciPCa（7%；95%CI：5，20），结果差异为-3%（95%CI：-2至4；P=0.2），相对检出率为0.1。SBx在29名(16%)男性中检测到ciPCa。MPMRI加上micro-US在51/178名男性中检测到csPCa，没有添加SBx的额外情况。同样，MTBx加micro-USTBx加SBx在35/178名男性（20％；95％CI：18，37）中检测到ciPCa，而micro-US途径（P=0.002）中的9（5％）和mpMRI加micro-US途径中的14/178（8％；95％CI：6，26）（P=0.004）。
结论：结论：联合的micro-US/mpMRI方法可以表征不一致病变的活检初治患者的原发疾病，可能避免SBx。需要进一步的研究来验证我们的发现并评估micro-US在减少不必要的活检中的作用。
方法：我们在mpMRI和micro-US分析了178例疑似PCa和不一致病变的未接受活检的男性。所有患者都接受了mpMRI，然后是micro-US，后者在活检前立即进行。影像学检查结果被盲目解释，其次是针对性和SBx。中位年龄为63岁(IQR，57-70），中位前列腺特异性抗原水平为7ng/mL(IQR，5-9ng/mL)，前列腺体积中位数为49cm^3(IQR，35-64厘米^3）。总的来说,86/178（48%）患者被诊断为PCa，51/178（29%）与csPCa。
结果：Micro-USTBx在36/178名男性中检测到csPCa（20％；95％CI：26-46），MTBx在28/178名男性中检测到csPCa（16％；95％CI：36-50），结果差异为-8%（95%CI：-10，4；P=0.022），相对检出率为0.043。Micro-USTBx在9/178名男性中检测到ciPCa（5％；95％CI：3，15），而MTBx在12/178名男性中检测到ciPCa（7%；95%CI：5，20），结果差异为-3%（95%CI：-2至4；P=0.2），相对检出率为0.1。SBx在29名(16%)男性中检测到ciPCa。MPMRI加上micro-US在51/178名男性中检测到csPCa，没有添加SBx的额外情况。同样，MTBx加micro-USTBx加SBx在35/178名男性（20％；95％CI：18，37）中检测到ciPCa，而micro-US途径（P=0.002）中的9（5％）和mpMRI加micro-US途径中的14/178（8％；95％CI：6，26）（P=0.004）。
结论：结论：联合的micro-US/mpMRI方法可以表征不一致病变的活检初治患者的原发疾病，可能避免SBx。需要进一步的研究来验证我们的发现并评估micro-US在减少不必要的活检中的作用。
