PURPOSE To assess the performance of EAU risk classification in PCa patients according to the biopsy pathway (standard versus MRI guided) and to develop a new, more accurate, targeted biopsy (TB)-based classification. MATERIALS AND METHODS We included 1345 patients consecutively operated by radical prostatectomy (RP) since 2014, when MRI and TB were introduced in the diagnostic pathway. Patients underwent systematic biopsy (SB) only (n = 819) or SB and TB (n = 526) prior to RP during the same time period. Pathological and biochemical outcomes were compared between PCa men undergoing SB (SB cohort) and a combination of TB and SB (TB cohort). Kaplan-Meier and Cox regression models were used to assess biochemical recurrence-free survival (RFS). RESULTS Both cohorts were comparable regarding final pathology and RFS (p = 0.538). The EAU risk classification accurately predicted outcomes in SB cohort, but did not significantly separate low from intermediate risk in TB cohort (p = 0.791). In TB cohort, the new proposed three-group risk classification significantly improved the recurrence risk prediction compared with the EAU risk classification: HR 4 (versus HR 1.2, p = 0.009) for intermediate, and HR 15 (versus HR 6.5, p < 0.001) in high-risk groups, respectively. A fourth group defining very high-risk cases (≥ T2c clinical stage or grade group 5) was also proposed. CONCLUSIONS The new classification integrating TB findings we propose meaningfully improves the recurrence prediction after surgery in patients undergoing a TB-based diagnostic pathway, compared with standard EAU risk classification which is still relevant for patients undergoing only SB. External validation is needed.

中文翻译：

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在影像引导的诊断途径时代，前列腺癌EAU风险组分类的准确性降低：基于MRI靶向活检和术后肿瘤早期结果的新分类建议。

目的根据活检途径（标准与MRI指导）评估PCa患者EAU风险分类的表现，并开发新的，更准确的，针对性的活检（TB）分类。材料与方法自2014年将MRI和TB引入诊断途径以来，我们纳入了1345例连续接受根治性前列腺切除术（RP）的患者。患者在同一时间段内仅接受过系统活检（SB）（n = 819）或SB和TB（n = 526）。比较了接受SB（SB队列）和TB与SB合并（TB队列）的PCa男性的病理学和生化结果。Kaplan-Meier和Cox回归模型用于评估无生化复发的生存期（RFS）。结果两组患者在最终病理和RFS方面均具有可比性（p = 0.538）。EAU风险分类能够准确预测SB队列的结局，但并未将TB队列的低风险与中等风险区分开（p = 0.791）。与EAU风险分类相比，在结核病队列研究中，新提议的三组风险分类显着改善了复发风险预测：中级HR 4（相对于HR 1.2，p = 0.009）和HR 15（相对于HR 6.5，p <0.001） ）分别位于高风险人群中。还提议了第四组定义极高风险病例（≥T2c临床阶段或5级组）。结论与标准EAU风险分类法（仅适用于仅接受SB的患者）相比，我们提出的结合结核病调查结果的新分类法有意义地改善了接受基于结核病的诊断途径的患者术后的复发预测。