ObjectivesTo evaluate the additional prostate cancer detection yield and clinical implications of performing contralateral systematic biopsies in men with unilateral suspicious magnetic resonance imaging (MRI) findings undergoing MRI‐guided transperineal (TP) biopsies in an outpatient clinic.Patients and MethodsA prospective study of 655 consecutive men with unilateral MRI suspicious findings undergoing office‐based MRI‐guided TP biopsies between May 2022 and December 2023. All men had pre‐biopsy MRI followed by MRI‐guided TP fusion biopsies with at least four targeted cores per lesion plus five contralateral systematic biopsies. The primary objective was the clinically significant prostate cancer (csPCa) detection rate of contralateral systematic biopsies in men with no or insignificant PCa on targeted biopsies. Secondary objectives included the impact of contralateral biopsies on PCa grade upgrading, additional insignificant PCa diagnoses, and the clinical implications of multifocal csPCa detected on both targeted and contralateral cores.ResultsAny and csPCa (Gleason Grade Group [GG] ≥2) was detected in 564/655 (85%) and 471/655 (71%) men with a median age of 66 years and PSA level of 7.6 ng/mL. Overall, seven of 655 (1%) men had csPCa detected by contralateral systematic biopsies missed on MRI‐targeted biopsy, all of whom had low‐volume Gleason GG 2 PCa eligible for active surveillance. Furthermore, 70/464 (15%) men with csPCa on MRI‐targeted biopsy had matching Gleason GG 2–5 PCa on contralateral biopsy, and another seven had higher Gleason GG. However, the additional information from contralateral biopsies did not seem to influence whole‐gland treatment allocation and nerve‐sparing during surgery.ConclusionContralateral systematic biopsies in men with unilateral MRI findings undergoing MRI‐guided TP targeted biopsies have limited value for csPCa detection and risk assessment for whole‐gland treatment but may be important for determining PCa multifocality considering focal therapy eligibility.

中文翻译：

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对侧活检对侧 MRI 病灶男性的临床价值


目的评估在门诊接受 MRI 引导下经会阴 （TP） 活检的单侧可疑磁共振成像 （MRI） 结果的男性进行对侧系统活检的额外前列腺癌检出率和临床意义。患者和方法一项前瞻性研究，对 2022 年 5 月至 2023 年 12 月期间接受基于办公室的 MRI 引导下 TP 活检的 655 名连续单侧 MRI 可疑结果的男性进行前瞻性研究。所有男性均进行活检前 MRI，然后进行 MRI 引导下的 TP 融合活检，每个病灶至少 4 个目标核心和 5 个对侧系统活检。主要目标是靶向活检中无 PCa 或无 PCa 的男性对侧系统活检的临床显着前列腺癌 （csPCa） 检出率。次要目标包括对侧活检对 PCa 分级升级的影响、其他不重要的 PCa 诊断，以及在目标和对侧核心上检测到多灶性 csPCa 的临床意义。结果在 564/655 例 （85%） 和 471/655 （71%） 男性中检测到 Any 和 csPCa （Gleason Grade Group [GG] ≥2），中位年龄为 66 岁，PSA 水平为 7.6 ng/mL。总体而言，655 名男性中有 7 名 （1%） 的 csPCa 是通过 MRI 靶向活检遗漏的对侧系统活检检测到的，他们都患有符合主动监测条件的低容量 Gleason GG 2 PCa。此外，70/464 （15%） 的 MRI 靶向活检 csPCa 男性在对侧活检中匹配 Gleason GG 2-5 PCa，另外 7 例 Gleason GG 更高。然而，来自对侧活检的额外信息似乎不会影响手术过程中的全腺治疗分配和神经保留。结论接受 MRI 引导下 TP 靶向活检的单侧 MRI 发现男性的对侧系统活检对 csPCa 检测和全腺治疗风险评估的价值有限，但考虑到局部治疗资格，对于确定 PCa 多病灶可能很重要。