Resultados de resonancia magnética y rebiopsia confirmatoria durante la vigilancia activa en pacientes con cáncer de próstata de grupo de grado 2

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas Pub Date : 2026-05-01 Epub Date: 2026-01-02 DOI:10.1016/j.acuro.2025.501924

F. Sanguedolce , M. Baboudjian , A. Redondo Ríos , R. Leni , M. Oderda , A. Peyrottes , C. Kesch , M. Al-Nader , A. Uleri , T. Long-Depaquit , C. Dariane , H. Baud , J. Olivier , V. Benard , O. Windisch , M. Valerio , G. Gandaglia , G. Ploussard

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引用次数: 0

Abstract

Introduction

To report the results of confirmatory MRI/biopsy in a European cohort of MRI-selected patients with Gleason Grade Group (GG) 2 prostate cancer (PCa) in active surveillance (AS).

Methods

Multicenter study enrolled patients with GG2 PCa managed by AS between 2016-2024. Serial MRI scans were interpreted according to PRECISE recommendations. Diagnostic accuracy of PRECISE score to predict upgrading on confirmatory biopsy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% Confident Intervals (CIs).

Results

A total of 77 patients with GG2 PCa was included, with a PI-RADS 4-5 in 48 patients (63%). On confirmatory MRI, 32 cases were classified as PRECISE 4-5 (42%). On confirmatory biopsy, 39 patients (51%) were downgraded to GG0-1, 27 patients (35%) were GG 2 and upgrading occurred in 11 cases (14%). Sensitivity, specificity, NPV and PPV of the PRECISE score 4-5 to detect upgrading was 63.6% (95%CI 31–89), 62.1% (95%CI, 49-74), 91.1% (95%CI, 82-96) and 21.8% (95%CI, 14-32), respectively. In multivariable Cox hazards regression analysis, downgrading at confirmatory biopsy was significantly associated with a reduced risk of subsequent GG3 reclassification (HR 0.125, 95%CI, 0.277-0.560, p = 0.002) and definitive treatment (HR 0.409, 95%CI, 0.199-0.839, p = 0.015).

Conclusion

MRI selection of patients with GG2 PCa in AS allows better initial characterization of the disease. The absence of progression on MRI indicates a very low risk of grade reclassification, but signs of imaging progression are not always predictive of progression and should not be considered alone for prompting active treatment.

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2级前列腺癌患者积极监测期间的核磁共振和确认活组织检查结果

在主动监测（AS）中，对MRI选择的Gleason分级组（GG） 2前列腺癌（PCa）患者进行欧洲队列验证性MRI/活检的结果。方法多中心研究纳入2016-2024年间由AS管理的GG2 PCa患者。连续MRI扫描根据PRECISE建议进行解释。通过计算95%可信区间（ci）的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）来评估PRECISE评分预测确诊活检升级的诊断准确性。结果共纳入77例GG2型PCa患者，48例（63%）患者PI-RADS为4-5。在证实性MRI上，32例（42%）被分类为PRECISE 4-5。在确认性活检中，39例（51%）患者降级为GG0-1, 27例（35%）患者降级为gg2, 11例（14%）患者升级。PRECISE评分4-5检测肿瘤升级的敏感性、特异性、NPV和PPV分别为63.6% （95%CI 31-89）、62.1% （95%CI 49-74）、91.1% （95%CI 82-96）和21.8% （95%CI 14-32）。在多变量Cox风险回归分析中，确认性活检降级与随后GG3重新分类的风险降低（HR 0.125, 95%CI, 0.277-0.560, p = 0.002）和最终治疗（HR 0.409, 95%CI, 0.199-0.839, p = 0.015）显著相关。结论对AS中GG2 PCa患者的mri选择可以更好地初步表征该疾病。MRI上没有进展表明分级重分类的风险很低，但影像学进展的迹象并不总是预测进展，不应单独考虑是否积极治疗。

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

Actas urologicas espanolas UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

46 days

期刊介绍： Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.