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.
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。