Background

The use of 12-core systematic prostate biopsy is associated with diagnostic inaccuracy that contributes to both overdiagnosis and underdiagnosis of prostate cancer. Biopsies performed with magnetic resonance imaging (MRI) targeting may reduce the misclassification of prostate cancer in men with MRI-visible lesions.

Methods

Men with MRI-visible prostate lesions underwent both MRI-targeted and systematic biopsy. The primary outcome was cancer detection according to grade group (i.e., a clustering of Gleason grades). Grade group 1 refers to clinically insignificant disease; grade group 2 or higher, cancer with favorable intermediate risk or worse; and grade group 3 or higher, cancer with unfavorable intermediate risk or worse. Among the men who underwent subsequent radical prostatectomy, upgrading and downgrading of grade group from biopsy to whole-mount histopathological analysis of surgical specimens were recorded. Secondary outcomes were the detection of cancers of grade group 2 or higher and grade group 3 or higher, cancer detection stratified by previous biopsy status, and grade reclassification between biopsy and radical prostatectomy.

Results

A total of 2103 men underwent both biopsy methods; cancer was diagnosed in 1312 (62.4%) by a combination of the two methods (combined biopsy), and 404 (19.2%) underwent radical prostatectomy. Cancer detection rates on MRI-targeted biopsy were significantly lower than on systematic biopsy for grade group 1 cancers and significantly higher for grade groups 3 through 5 (P<0.01 for all comparisons). Combined biopsy led to cancer diagnoses in 208 more men (9.9%) than with either method alone and to upgrading to a higher grade group in 458 men (21.8%). However, if only MRI-target biopsies had been performed, 8.8% of clinically significant cancers (grade group ≥3) would have been misclassified. Among the 404 men who underwent subsequent radical prostatectomy, combined biopsy was associated with the fewest upgrades to grade group 3 or higher on histopathological analysis of surgical specimens (3.5%), as compared with MRI-targeted biopsy (8.7%) and systematic biopsy (16.8%).

Conclusions

Among patients with MRI-visible lesions, combined biopsy led to more detection of all prostate cancers. However, MRI-targeted biopsy alone underestimated the histologic grade of some tumors. After radical prostatectomy, upgrades to grade group 3 or higher on histopathological analysis were substantially lower after combined biopsy. (Funded by the National Institutes of Health and others; Trio Study ClinicalTrials.gov number, NCT00102544.)

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Diagnosing and Grading Prostate Cancer
 02:06

中文翻译：

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用于前列腺癌诊断的 MRI 靶向、系统和联合活检。

背景

使用 12 核系统性前列腺活检与诊断不准确有关，导致前列腺癌的过度诊断和诊断不足。使用磁共振成像 (MRI) 靶向进行的活检可能会减少男性对 MRI 可见病变的前列腺癌的错误分类。

方法

患有 MRI 可见前列腺病变的男性接受了 MRI 靶向活检和系统活检。主要结果是根据等级组（即 Gleason 等级的聚类）的癌症检测。1级是指临床上不重要的疾病；2 级或更高级别，具有良好中等风险或更严重的癌症；3 级或更高级别，具有不利中等风险或更严重的癌症。在随后接受根治性前列腺切除术的男性中，记录了等级组从活检到手术标本的整体组织病理学分析的升级和降级。次要结果是检测到 2 级或更高级别和 3 级或更高级别的癌症、按先前活检状态分层的癌症检测以及活检和根治性前列腺切除术之间的分级重新分类。

结果

共有 2103 名男性接受了两种活检方法；1312 人（62.4%）通过这两种方法（联合活检）诊断出癌症，404 人（19.2%）接受了根治性前列腺切除术。MRI 靶向活检的癌症检出率显着低于 1 级癌症的系统活检，而 3 至 5 级癌症的检出率显着高于（所有比较 P<0.01）。联合活检导致癌症诊断的男性比单独使用任何一种方法多 208 人（9.9%），并在 458 名男性（21.8%）中升级到更高级别的组。然而，如果只进行 MRI 靶向活检，8.8% 的具有临床意义的癌症（≥3 级）将被错误分类。在随后接受根治性前列腺切除术的 404 名男性中，与 MRI 靶向活检（8.7%）和系统活检相比，联合活检与手术标本组织病理学分析（3.5%）升级到 3 级或更高级别的比例最少相关。 16.8%）。

结论

在有 MRI 可见病变的患者中，联合活检可以更多地检测出所有前列腺癌。然而，仅 MRI 靶向活检就低估了某些肿瘤的组织学分级。根治性前列腺切除术后，联合活检后组织病理学分析升级到 3 级或更高级别的情况显着降低。（由美国国立卫生研究院和其他机构资助；Trio Study ClinicalTrials.gov 编号，NCT00102544。）

快速视频摘要
诊断和分级前列腺癌
 02:06