PURPOSE Men diagnosed with prostate cancer (PCa) considering active surveillance (AS) are recommended confirmatory biopsy (CBx). Whether this is necessary in the era of MRI-informed biopsies is questionable. MATERIALS AND METHODS We studied men with grade group (GG) 1 PCa at diagnostic biopsy (DBx) considering AS who underwent MRI and CBx (systematic + targeted) within 18 months. Outcomes were grade reclassification to GG ≥ 2 and GG ≥ 3 and reclassification to unfavorable intermediate-risk (UIR) disease. Subset analyses were performed for men with (1) MRI before DBx and (2) MRI after DBx. RESULTS Five hundred twenty-two men had GG1 PCa at DBx. At CBx, 20% reclassified to GG ≥ 2, 12% to UIR disease, and 5.6% to GG ≥ 3. Of the 306 with positive MRI (PI-RADS > 3), 27% reclassified to GG ≥ 2 and 16% to UIR disease; men with negative MRI experienced these outcomes at rates of 9.2% and 5.5%, respectively. There were no differences in reclassification outcomes based on MRI timing (group A vs B), and neither PSA density nor prostate volume added to MRI information. In men with MRI targets, approximately one-third of GG > 2 reclassification events were only captured by systematic biopsy core(s). CONCLUSIONS Reclassification rates at CBx were high in men with positive MRI, but < 10% for all reclassification outcomes in men with negative MRI (95% CI, 5.8%-14% for GG > 2; 95% CI, 2.9%-10% for UIR; 95% CI, 0.8%-5.3% for GG > 3). Our data support systematic + targeted CBx for men with positive MRI considering AS, whereas men with GG1 cancer and negative MRI should be able to defer CBx.

中文翻译：

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在多参数 MRI 时代，对 1 级前列腺癌男性患者进行主动监测是否仍然需要确认性活检？


目的 被诊断患有前列腺癌 （PCa） 的男性考虑主动监测 （AS） 推荐进行确认性活检 （CBx）。在 MRI 知情活检时代，这是否必要是值得怀疑的。材料和方法 我们研究了在诊断性活检 （DBx） 中具有等级组 （GG） 1 PCa 的男性，考虑到 AS 在 18 个月内接受了 MRI 和 CBx（系统性 + 靶向）。结局是分级再分类为 GG ≥ 2 和 GG ≥ 3，再分类为不良中危 （UIR） 疾病。对 （1） DBx 前 MRI 和 （2） DBx 后 MRI 的男性进行亚组分析。结果 522 名男性在 DBx 时有 GG1 PCa。在 CBx 中，20% 被重新分类为 GG ≥ 2,12% 被重新分类为 UIR 疾病，5.6% 被重新分类为 GG ≥ 3。在 306 例 MRI 阳性 （PI-RADS > 3） 中，27% 重新分类为 GG ≥ 2,16% 重新分类为 UIR 疾病;MRI 阴性的男性经历这些结果的比率分别为 9.2% 和 5.5%。基于 MRI 时间的重新分类结果没有差异 （A 组与 B 组），并且 PSA 密度和前列腺体积均未添加到 MRI 信息中。在具有 MRI 靶标的男性中，大约 1/3 的 GG > 2 重分类事件仅由系统活检核心捕获。结论 MRI 阳性男性 CBx 重分类率高，但 MRI 阴性男性所有重分类结果的 < 10% （95% CI，GG > 5.8%-14%;95% CI，UIR 2.9%-10%;95% CI，GG > 0.8%-5.3%）。我们的数据支持考虑 AS 的 MRI 阳性男性的系统 + 靶向 CBx，而 GG1 癌症和 MRI 阴性的男性应该能够推迟 CBx。