PURPOSE To assess the upstaging/upgrading rates of low-risk prostate cancer (PCa) according to the biopsy scheme used (systematic (SB), targeted biopsies (TB), or both) in the setting of positive pre-biopsy MRI. PATIENTS AND METHODS We included 143 consecutive men fulfilling the Toronto University active surveillance (AS) criteria who underwent a pre-biopsy positive MRI, a combination of SB and software-based fusion TB, and a radical prostatectomy, in two expert centres. The primary endpoints were the pathological upgrading and upstaging rates. Overall unfavourable disease (OUD) was defined by any pT3-4 and/or pN1 and/or ≥ GG 3. RESULTS Using TB alone would have missed 21.7% of cancers including 16.7% of ≥ GG 3. The use of TB was significantly associated with a lower risk of ≥ Grade Group (GG) 3 disease (p < 0.006) in RP specimens. Combination of SB and TB lowered this risk by 39%, compared with TB alone. The biopsy scheme did not affect the upstaging rates which were substantial even in case of combination scheme (from 37 to 46%). OUD was detected in approximately 50% of cases. The presence of high grade on TB was the only independent predictive factor for both ≥ GG 2 (p = 0.015) and ≥ GG 3 (p = 0.023) in RP specimens. CONCLUSIONS High grade on TB biopsies represented the major predictor of upgrading. Combination of SB and TB better defined the sub-group of patients having the lowest risk of reclassification, compared with TB or SB alone. The risk of non-organ-confined disease remained high, and could not be accurately predicted by MRI or systematic/targeted biopsy features.

中文翻译：

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单独进行系统性，以MRI为目标的活检或联合进行以进行主动监测的MRI阳性低危前列腺癌患者对不良疾病的预测。

目的在活检前MRI阳性的情况下，根据所使用的活检方案（系统性（SB），靶向活检（TB）或两者）评估低风险前列腺癌（PCa）的升级/升级率。患者和方法我们在两个专家中心纳入了143例符合多伦多大学主动监测（AS）标准的连续男性，这些男性接受了活检前阳性MRI，SB和基于软件的融合TB的结合以及根治性前列腺切除术。主要终点是病理升级和升级率。总体不良疾病（OUD）由任何pT3-4和/或pN1和/或≥GG 3定义。结果仅使用TB就能漏诊21.7％的癌症，包括≥GG 3的16.7％。使用TB显着相关在RP标本中具有≥Group Group（GG）3疾病（p <0.006）的较低风险。与单独的结核病相比，SB和TB的结合使这种风险降低了39％。活检方案不影响升级率，即使在联合方案的情况下，升级率也很高（从37％增至46％）。在大约50％的病例中检测到OUD。在RP标本中，≥GG 2（p = 0.015）和≥GG 3（p = 0.023）结核病的高品位是唯一的独立预测因素。结论结核活检的高分是升级的主要预测指标。与单独的TB或SB相比，SB和TB的组合更好地定义了具有最低重分类风险的患者亚组。非器官限定疾病的风险仍然很高，并且无法通过MRI或系统/有针对性的活检特征准确预测。活检方案不影响升级率，即使在联合方案的情况下，升级率也很高（从37％增至46％）。在大约50％的病例中检测到OUD。在RP标本中，≥GG 2（p = 0.015）和≥GG 3（p = 0.023）结核病的高品位是唯一的独立预测因素。结论结核活检的高分是升级的主要预测指标。与单独的TB或SB相比，SB和TB的组合更好地定义了具有最低重分类风险的患者亚组。非器官限定疾病的风险仍然很高，并且无法通过MRI或系统/有针对性的活检特征准确预测。活检方案不影响升级率，即使在联合方案的情况下，升级率也很高（从37％增至46％）。在大约50％的病例中检测到OUD。在RP标本中，≥GG 2（p = 0.015）和≥GG 3（p = 0.023）结核病的高品位是唯一的独立预测因素。结论结核活检的高分是升级的主要预测指标。与单独的TB或SB相比，SB和TB的组合更好地定义了具有最低重分类风险的患者亚组。非器官限定疾病的风险仍然很高，并且无法通过MRI或系统/有针对性的活检特征准确预测。在RP标本中，≥GG 2（p = 0.015）和≥GG 3（p = 0.023）结核病的高品位是唯一的独立预测因素。结论结核活检的高分是升级的主要预测指标。与单独的TB或SB相比，SB和TB的组合更好地定义了具有最低重分类风险的患者亚组。非器官限定疾病的风险仍然很高，并且无法通过MRI或系统/有针对性的活检特征准确预测。在RP标本中，≥GG 2（p = 0.015）和≥GG 3（p = 0.023）结核病的高品位是唯一的独立预测因素。结论结核活检的高分是升级的主要预测指标。与单独的TB或SB相比，SB和TB的组合更好地定义了具有最低重分类风险的患者亚组。非器官限定疾病的风险仍然很高，并且无法通过MRI或系统/有针对性的活检特征准确预测。