Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions - an EAU-YAU study enhancing prostate cancer detection.

IF 5.1 2区 医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-11-05 DOI:10.1038/s41391-024-00904-1
Fabio Zattoni, Giorgio Gandaglia, Roderick C N van den Bergh, Giancarlo Marra, Massimo Valerio, Alberto Martini, Jonathan Olivier, Ignacio Puche-SanzI, Pawel Rajwa, Martina Maggi, Riccardo Campi, Rossella Nicoletti, Daniele Amparore, Sabrina De Cillis, Junlong Zhuang, Hongqian Guo, Andrea Fuschi, Alessandro Veccia, Francesco Ditonno, Leonor J Paulino Pereira, Alessandro Marquis, Francesco Barletta, Riccardo Leni, Veeru Kasivisvanathan, Alessandro Antonelli, Juan Gomez Rivas, Sebastiaan Remmers, Monique J Roobol, Alberto Briganti, Fabrizio Dal Moro, Giacomo Novara
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Abstract

Purpose: To investigate the detection and predictors of prostate cancer (PCA) and clinically significant prostate cancer (csPCA) in patients with positive multiparametric MRI (mpMRI) followed by a negative MRI - guided target biopsy (TB) and systematic biopsy (SB).

Materials and methods: This retrospective multicenter study included 694 patients from 10 tertiary referral centers with an initial positive mpMRI (PI-RADS ≥ 3) and negative results on both MRI-TB and SB. Patients were classified into three groups based on follow-up: Group 1 (prostate re-biopsy without new mpMRI), Group 2 (standardized second prostate mpMRI and subsequent re-biopsy), and Group 3 (follow-up with mpMRIs and biopsy based on clinical and radiological triggers). The primary outcomes were the detection of any PCA and csPCA during follow up. Study groups were compared according to their probability of PCA and csPCA assessed with the ERSPC-MRI risk calculator. Statistical analysis included Kaplan - Meier analysis, Cox regression, and multivariable analysis for the detection of (cs)PCa.

Results: The overall detection of PCA and csPCA was 26.8% and 19.3%, respectively, with varying rates in different PI-RADS groups. Group 3 had the highest 2-year and 5-year PCA-free survival (94 and 84%) and csPCA - free survival (96 and 86%). Multivariable analysis revealed a significantly higher risk of PCA and csPCA in Group 1 and 2 compared to Group 3 (p < 0.01). Clinical and radiological predictors for PCA and csPCA included higher age, prostate volume, PI-RADS score, the presence of atypical small acinar proliferation (ASAP), and a smaller number of TB and SB performed during the initial biopsy. Study limitations, include the retrospective design and reliance on clinical and radiological triggers for follow-up decisions.

Conclusions: Patients with positive mpMRI but negative TB and SB results exhibit varying rates of PCA and csPCA depending on the follow up scheme. Tailored follow-up strategies are essential for optimal management in this clinical scenario.

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对初始 mpMRI 目标阴性和系统活检 PI-RADS ≥ 3 病变的患者进行随访--加强前列腺癌检测的 EAU-YAU 研究。
目的:研究多参数磁共振成像(mpMRI)阳性、磁共振成像引导靶向活检(TB)和系统性活检(SB)阴性患者中前列腺癌(PCA)和临床意义前列腺癌(csPCA)的检测和预测因素:这项回顾性多中心研究纳入了来自 10 个三级转诊中心的 694 例患者,这些患者最初的 mpMRI 呈阳性(PI-RADS ≥ 3),但 MRI-TB 和 SB 结果均为阴性。根据随访情况将患者分为三组:第一组(进行前列腺再活检,不进行新的 mpMRI)、第二组(进行标准化的第二次前列腺 mpMRI 和随后的再活检)和第三组(根据临床和放射学触发因素进行 mpMRI 和活检的随访)。主要结果是在随访期间发现任何 PCA 和 csPCA。研究组根据ERSPC-MRI风险计算器评估的PCA和csPCA概率进行比较。统计分析包括卡普兰-麦尔分析、Cox回归和检测(cs)PCa的多变量分析:结果:PCA和csPCA的总体检出率分别为26.8%和19.3%,不同的PI-RADS组别检出率不同。第3组的2年和5年无PCA生存率最高(分别为94%和84%),无csPCA生存率最高(分别为96%和86%)。多变量分析显示,与第 3 组相比,第 1 组和第 2 组发生 PCA 和 csPCA 的风险明显更高(p 结论:第 1 组和第 2 组发生 PCA 和 csPCA 的风险明显高于第 3 组):mpMRI 阳性但 TB 和 SB 结果为阴性的患者,其 PCA 和 csPCA 发生率因随访计划而异。在这种临床情况下,量身定制的随访策略对于优化管理至关重要。
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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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