Intensive sampling of the umbra and penumbra improves clinically significant prostate cancer detection and reduces risk of grade group upgrading at radical prostatectomy.

Autor: Lee AYM; Department of Urology, Singapore General Hospital, Academia, Level 5, Outram Road, Singapore, 169608, Singapore. alvin.lee@mohh.com.sg., Chen K; Department of Urology, Singapore General Hospital, Academia, Level 5, Outram Road, Singapore, 169608, Singapore., Cheng CWS; Department of Urology, Singapore General Hospital, Academia, Level 5, Outram Road, Singapore, 169608, Singapore.; Department of Urology, Sengkang General Hospital, Singapore, Singapore., Ho HSS; Department of Urology, Singapore General Hospital, Academia, Level 5, Outram Road, Singapore, 169608, Singapore., Yuen JSP; Department of Urology, Singapore General Hospital, Academia, Level 5, Outram Road, Singapore, 169608, Singapore., Ngo NT; Department of Pathology, Singapore General Hospital, Singapore, Singapore., Law YM; Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore., Tay KJ; Department of Urology, Singapore General Hospital, Academia, Level 5, Outram Road, Singapore, 169608, Singapore.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2023 Aug; Vol. 41 (8), pp. 2265-2271. Date of Electronic Publication: 2023 Jul 03.
DOI: 10.1007/s00345-023-04499-5
Abstrakt: Purpose: Our objective is to evaluate the clinically significant prostate cancer detection rate of overlapping and perilesional systematic biopsy cores and its impact on grade group (GG) concordance at prostatectomy.
Materials and Methods: Biopsy maps of those undergoing MRI-targeted (TB) and systematic biopsy (SB) were reviewed to reclassify systematic cores. Perilesional (PL) cores were defined as adjacent cores within 10 mm of the target lesion ("penumbra") whilst overlap (OL) cores were defined as cores within the ROI itself ("umbra"). All other cores were designated as distant cores (DC). The incremental csPCa detection rate (GG ≥ 2) and the rate of GG upgrading on prostatectomy as OL, PL and DC sequentially added to TB were determined.
Results: Out of the 398 patients included, the median number of OL and PL cores was 5 (IQR 4-7) and 5 (IQR 3-6) respectively. OL cores detected more csPCa than PL cores (31 vs 16%, p < 0.001). OL and PL cores improved the csPCa detection rate of TB from 34 to 39% (p < 0.001) and 37% (p = 0.001) respectively. TB+OL+PL had greater csPCa detection compared to just TB+OL (41 vs 39%, p = 0.016) and TB+PL (41 vs 37%, p < 0.001). Of the 104 patients who underwent prostatectomy, GG upgrading rate for TB+OL+PL was lower compared to TB (21 vs 36%, p < 0.001) and was not significantly different compared to TB+OL+PL+DC (21 vs 19%, p = 0.500).
Conclusion: A biopsy strategy incorporating both intensive sampling of the umbra and penumbra improved csPCa detection and reduced risk of GG upgrading at prostatectomy.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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