Prostate Cancer Risk Stratification Using Magnetic Resonance Imaging-Ultrasound Fusion versus Systematic Prostate Biopsy
Menée à partir de données portant sur 713 patients ayant bénéficié entre 2017 et 2021 d'une biopsie prostatique (âge médian : 67 ans), cette étude évalue, du point de vue du taux de reclassement des lésions détectées, l'intérêt d'ajouter, à une biopsie prostatique systématique, une biopsie guidée à l'aide de fusions d'images échographiques et d'IRM
Background : Image-guided approaches improve the diagnostic yield of prostate biopsy and frequently modify estimates of clinical risk. To better understand the impact of MRI-ultrasound fusion prostate biopsy (MRF-TB) on risk assessment, we compared the distribution of National Comprehensive Cancer Network (NCCN) risk groupings as calculated from both MRF-TB and systematic biopsy (SB) alone.
Methods : We performed a retrospective analysis of 713 patients who underwent MRF-TB from January 2017 to July 2021. The primary study objective was to compare the distribution of NCCN risk groupings obtained using MRF-TB (systematic + targeted) vs SB.
Results : SB alone classified 10% and 18.7% as very-low and low risk, respectively, while MRF-TB classified 10.5% and 16.1% as very-low and low risk. Among men with benign, low, and favorable-intermediate-risk disease on SB alone, 4.6% were reclassified as high and very high-risk on MRF-TB. Of 207 patients electing active surveillance as management, 64 (31%), 91 (44%), 42 (20.2%), and 10 (4.8%) were classified as very-low, low, and favorable-intermediate and unfavorable-intermediate risk criteria, respectively. When utilizing SB alone, 204 patients (28.7%) were classified as having combined very low and low NCCN risk, while 190 men (26.6%) received this classification when using MRF-TB.
Conclusion : Addition of MRF-TB to SB might change eligibility for active surveillance in only a small proportion of patients with prostate cancer. Our findings support the need for routine use of quantitative risk assessment over risk groupings to promote more nuanced decision-making for localized cancer.
JNCI Cancer Spectrum , article en libre accès, 2022