Role of region-of-interest magnetic resonance imaging fusion biopsy in mitigating overtreatment of localized prostate cancer – A retrospective cohort study

IF 2.9 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Carrie Wang , Purvish Trivedi , Esther Katende , Varun Awasthi , Riley Smith , Ryan Putney , Yahya Bondokji , Jong Y. Park , Jasreman Dhillon , Kosj Yamoah
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Abstract

Background

Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography.

Methods

The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-of-interest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS).

Results

Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment (P = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort (P = .002).

Conclusion

Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.
感兴趣区域磁共振成像融合活检在减轻局限性前列腺癌过度治疗中的作用-一项回顾性队列研究
传统的基于超声的前列腺活检采用经直肠方法对12个核进行系统采样。磁共振成像(MRI)融合活检采用一种有针对性的方法,首先通过MRI识别临床怀疑前列腺癌(PCa)的感兴趣区域(ROI),然后在超声辅助下进行前列腺活检。方法采用单中心机构回顾性队列研究,纳入442名推荐行局部前列腺癌治疗的男性。队列A (n = 346)包括接受mri引导下TRUS活检的患者,其中包括标准的12核TRUS活检和同时进行的mri靶向活检。队列B (n = 96)包括仅接受标准TRUS活检的患者。主要终点是Gleason再分类,定义为队列a中标准TRUS和目标感兴趣区域(ROI)活检之间Gleason评分的变化。次要终点通过分析接受治疗的概率和主动监测(as)的持续时间来评估ROI活检在减轻过度治疗方面的作用。结果在标准活检无肿瘤的男性中,16.9 %在随后的ROI活检中显示Gleason病。此外,ROI组也有更长的时间接受初级治疗(P = .017),因为他们更有可能选择as(54 %)。最后,与非ROI队列相比,ROI组在AS上花费的中位数时间更长(P = .002)。结论在标准TRUS活检基础上增加多参数MRI (mpMRI)活检可提高前列腺癌的检出率。此外,mpMRI可以使患者安全地接受AS治疗,从而减少前列腺活检的需要,提高成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Journal of Radiology Open
European Journal of Radiology Open Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
4.10
自引率
5.00%
发文量
55
审稿时长
51 days
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