PURPOSE Serial biopsy is a mainstay for patients on active surveillance (AS) for prostate cancer. mpMRI targeting has become a standard. It is unclear whether targeted biopsy alone reliably identifies the dominant lesion, thereby obviating the need for systematic sampling. MATERIALS AND METHODS Participants enrolled in AS with early-stage prostate cancer (PSA < 20, cT1-2, GG1-2) and underwent 2+ systematic biopsy sessions with or without MR-targeted sampling. The findings for dominant Gleason Grade (GG) and tumor localization were assessed. RESULTS Among 821 men who underwent MR fusion biopsies, 82% were diagnosed with GG1 and 18% with GG2. Sixty-two percent had their first MR fusion biopsy as diagnostic or confirmatory. Across all fusion biopsies, MRI-targeted detection of GG and/or tumor location overlapped with systematic sampling for 95% of cases. For 5% of cases, systematic biopsy was unique in detecting GG and location outside the target. Most unique lesions detected outside the target had marginally aggressive features: 73% GG2 of low-volume and favorable histologic subtypes. CONCLUSIONS In men with MR fusion biopsies, targeting alone identified the dominant GG and location most of the time (95%); 25% of dominant lesions were contiguous to the target, suggesting that better sampling of the target improves detection. The remaining 5% of men had higher-grade, low-volume disease outside the targeted lesion of which only 2% had aggressive risk features. MR fusion targeting, without systematic sampling, may be sufficient to monitor men on AS. Few high-risk cancers are missed, all of limited volume and favorable histology.

中文翻译：

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靶向活检对于接受早期前列腺癌主动监测的男性来说就足够了。


目的 连续活检是接受前列腺癌主动监测 （AS） 患者的主要方法。mpMRI 靶向已成为一种标准。目前尚不清楚单独靶向活检是否能可靠地识别主要病灶，从而避免了系统取样的需要。材料和方法 参与者参加了患有早期前列腺癌 （PSA < 20、cT1-2、GG1-2） 的 AS 并接受了 2+ 次系统活检，有或没有 MR 靶向采样。评估了显性 Gleason 分级 （GG） 和肿瘤定位的结果。结果 在接受 MR 融合活检的 821 例男性中，82% 被诊断为 GG1,18% 被诊断为 GG2。62% 的患者进行了第一次 MR 融合活检作为诊断或确认。在所有融合活检中，95% 的病例的 MRI 靶向检测 GG 和/或肿瘤位置与系统取样重叠。对于 5% 的病例，系统活检在检测 GG 和目标外位置方面是独一无二的。在靶标外检测到的大多数独特病灶具有轻微的侵袭性特征： 73% GG2 为低体积和良好的组织学亚型。结论 在接受 MR 融合活检的男性中，大多数时候 （95%） 仅靶向确定了主要的 GG 和位置;25% 的显性病灶与目标相邻，表明更好的目标采样可以提高检测率。其余 5% 的男性在目标病灶之外患有更高级别、低容量的疾病，其中只有 2% 具有侵袭性风险特征。MR 融合靶向，无需系统采样，可能足以监测 AS 男性。很少有高危癌症被漏诊，所有癌症的体积有限且组织学良好。