2级前列腺癌患者的确认性活检结果：对早期治疗的影响

IF 3.2 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2025-02-01 DOI:10.1016/j.euros.2025.01.012

Riccardo Leni , Emily A. Vertosick , Nicole Liso , Oguz Akin , Sigrid V. Carlsson , Francesco Montorsi , Alberto Briganti , James A. Eastham , Samson W. Fine , Andrew J. Vickers , Behfar Ehdaie

{"title":"2级前列腺癌患者的确认性活检结果：对早期治疗的影响","authors":"Riccardo Leni , Emily A. Vertosick , Nicole Liso , Oguz Akin , Sigrid V. Carlsson , Francesco Montorsi , Alberto Briganti , James A. Eastham , Samson W. Fine , Andrew J. Vickers , Behfar Ehdaie","doi":"10.1016/j.euros.2025.01.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and objective</h3><div>Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx.</div></div><div><h3>Methods</h3><div>This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on initial Bx, and prostate-specific antigen (PSA) density.</div></div><div><h3>Key findings and limitations</h3><div>Among 301 patients, 62 (21%) were downgraded to GG 1 and 23 (8%) had no cancer on cBx. For patients with nonsuspicious MRI findings (PI-RADS 1–3; <em>n</em> = 123), the probability of having no pattern 4 on CBx was 34%, 20%, and 11% for 1, 2, and 3 mm of pattern 4 at initial Bx. For PI-RADS 4–5 without EPE on MRI (<em>n</em> = 146), the corresponding probabilities were 18%, 10%, and 5%. Patients with EPE on MRI (<em>n</em> = 32) had low probability (<10%) of having no pattern 4 on cBx irrespective of pattern 4 on initial Bx. Results using a model based on PSA density followed a similar trend. After applying the model in a cohort of patients with GG 2 cancer who immediately underwent surgery (<em>n</em> = 2275), we estimated that two-thirds would be eligible for cBx before treatment using a probability threshold of 5–10% for avoiding immediate surgery.</div></div><div><h3>Conclusions and clinical implications</h3><div>Patients with GG 2 prostate cancer, no evidence of EPE, and a few millimeters of pattern 4 should undergo cBx before proceeding to surgery. Further research should define the oncologic risk for such patients, refine the criteria for cBx in GG 2 disease, and assess methods for quantifying pattern 4 length in MRI-targeted cores.</div></div><div><h3>Patient summary</h3><div>For patients with grade group (GG) 2 prostate cancer, we found that the amount of Gleason pattern 4 cancer in the initial biopsy, PSA (prostate-specific antigen) density, and MRI (magnetic resonance imaging) findings help to identify men who are likely to be downgraded to less aggressive GG 1 cancer or no cancer at all on a repeat confirmatory biopsy. We assessed these predictors in a group of patients with similar characteristics who underwent immediate surgery, and found that approximately two-thirds would benefit from a confirmatory biopsy.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 46-53"},"PeriodicalIF":3.2000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management\",\"authors\":\"Riccardo Leni , Emily A. Vertosick , Nicole Liso , Oguz Akin , Sigrid V. Carlsson , Francesco Montorsi , Alberto Briganti , James A. Eastham , Samson W. Fine , Andrew J. Vickers , Behfar Ehdaie\",\"doi\":\"10.1016/j.euros.2025.01.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and objective</h3><div>Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx.</div></div><div><h3>Methods</h3><div>This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on initial Bx, and prostate-specific antigen (PSA) density.</div></div><div><h3>Key findings and limitations</h3><div>Among 301 patients, 62 (21%) were downgraded to GG 1 and 23 (8%) had no cancer on cBx. For patients with nonsuspicious MRI findings (PI-RADS 1–3; <em>n</em> = 123), the probability of having no pattern 4 on CBx was 34%, 20%, and 11% for 1, 2, and 3 mm of pattern 4 at initial Bx. For PI-RADS 4–5 without EPE on MRI (<em>n</em> = 146), the corresponding probabilities were 18%, 10%, and 5%. Patients with EPE on MRI (<em>n</em> = 32) had low probability (<10%) of having no pattern 4 on cBx irrespective of pattern 4 on initial Bx. Results using a model based on PSA density followed a similar trend. After applying the model in a cohort of patients with GG 2 cancer who immediately underwent surgery (<em>n</em> = 2275), we estimated that two-thirds would be eligible for cBx before treatment using a probability threshold of 5–10% for avoiding immediate surgery.</div></div><div><h3>Conclusions and clinical implications</h3><div>Patients with GG 2 prostate cancer, no evidence of EPE, and a few millimeters of pattern 4 should undergo cBx before proceeding to surgery. Further research should define the oncologic risk for such patients, refine the criteria for cBx in GG 2 disease, and assess methods for quantifying pattern 4 length in MRI-targeted cores.</div></div><div><h3>Patient summary</h3><div>For patients with grade group (GG) 2 prostate cancer, we found that the amount of Gleason pattern 4 cancer in the initial biopsy, PSA (prostate-specific antigen) density, and MRI (magnetic resonance imaging) findings help to identify men who are likely to be downgraded to less aggressive GG 1 cancer or no cancer at all on a repeat confirmatory biopsy. We assessed these predictors in a group of patients with similar characteristics who underwent immediate surgery, and found that approximately two-thirds would benefit from a confirmatory biopsy.</div></div>\",\"PeriodicalId\":12254,\"journal\":{\"name\":\"European Urology Open Science\",\"volume\":\"72 \",\"pages\":\"Pages 46-53\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Urology Open Science\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666168325000527\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Urology Open Science","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666168325000527","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景和目的指南中关于2级组（GG）前列腺癌伴确认性活检（cBx）的早期治疗的建议尚未得到很好的确立。我们的目的是通过评估cBx降至GG 1或无癌症的概率，确定哪些GG 2型癌症患者在治疗决策前应该接受cBx。方法对GG 2型前列腺癌行cBx的患者进行单机构回顾性分析。我们根据磁共振成像（MRI）前列腺成像报告和数据系统（PI-RADS）评分、MRI上前列腺外延伸（EPE）的存在、初始Bx上所有核心的模式4的总长度和前列腺特异性抗原（PSA）密度，对cBx上没有Gleason模式4的概率进行建模。在301例患者中，62例（21%）降为GG 1, 23例（8%）在cBx治疗时没有癌症。对于MRI无可疑表现的患者(PI-RADS 1-3；n = 123)，在初始Bx时，1、2和3 mm的纹4在CBx上没有纹4的概率分别为34%、20%和11%。对于MRI上无EPE的PI-RADS 4-5 (n = 146)，相应的概率分别为18%、10%和5%。MRI上有EPE的患者（n = 32）在cBx上没有4型的概率很低（<10%），与初始Bx上的4型无关。使用基于PSA密度的模型的结果也遵循类似的趋势。在将该模型应用于立即接受手术的GG 2癌患者队列（n = 2275）后，我们使用避免立即手术的5-10%的概率阈值估计三分之二的患者在治疗前有资格接受cBx治疗。结论和临床意义：GG - 2型前列腺癌患者，无EPE证据，且有几毫米的模式4，应在手术前进行cBx检查。进一步的研究应明确此类患者的肿瘤风险，完善gg2疾病的cBx标准，并评估量化mri靶核4型长度的方法。对于2级组（GG）前列腺癌患者，我们发现初始活检中Gleason 4型癌的数量、PSA（前列腺特异性抗原）密度和MRI（磁共振成像）结果有助于识别在重复确认性活检中可能降级为侵袭性较低的GG 1型癌或根本没有癌症的男性。我们在一组具有相似特征并立即接受手术的患者中评估了这些预测因素，发现大约三分之二的患者将从确证性活检中受益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management

Background and objective

Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx.

Methods

This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on initial Bx, and prostate-specific antigen (PSA) density.

Key findings and limitations

Among 301 patients, 62 (21%) were downgraded to GG 1 and 23 (8%) had no cancer on cBx. For patients with nonsuspicious MRI findings (PI-RADS 1–3; n = 123), the probability of having no pattern 4 on CBx was 34%, 20%, and 11% for 1, 2, and 3 mm of pattern 4 at initial Bx. For PI-RADS 4–5 without EPE on MRI (n = 146), the corresponding probabilities were 18%, 10%, and 5%. Patients with EPE on MRI (n = 32) had low probability (<10%) of having no pattern 4 on cBx irrespective of pattern 4 on initial Bx. Results using a model based on PSA density followed a similar trend. After applying the model in a cohort of patients with GG 2 cancer who immediately underwent surgery (n = 2275), we estimated that two-thirds would be eligible for cBx before treatment using a probability threshold of 5–10% for avoiding immediate surgery.

Conclusions and clinical implications

Patients with GG 2 prostate cancer, no evidence of EPE, and a few millimeters of pattern 4 should undergo cBx before proceeding to surgery. Further research should define the oncologic risk for such patients, refine the criteria for cBx in GG 2 disease, and assess methods for quantifying pattern 4 length in MRI-targeted cores.

Patient summary

For patients with grade group (GG) 2 prostate cancer, we found that the amount of Gleason pattern 4 cancer in the initial biopsy, PSA (prostate-specific antigen) density, and MRI (magnetic resonance imaging) findings help to identify men who are likely to be downgraded to less aggressive GG 1 cancer or no cancer at all on a repeat confirmatory biopsy. We assessed these predictors in a group of patients with similar characteristics who underwent immediate surgery, and found that approximately two-thirds would benefit from a confirmatory biopsy.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊