文章：

识别最佳前列腺活检策略以提高临床显著性前列腺癌检出率：针对初诊人群随机对照试验的系统综述与荟萃分析

Identifying Optimal Prostate Biopsy Strategy for the Detection Rate of Clinically Significant Prostate Cancer: A Systematic Review and Meta-Analysis of Randomised Controlled Trials (RCTs) in Biopsy-Naïve Population

原文发布日期：29 January 2025

DOI: 10.3390/cancers17030458

类型: Article

开放获取: 是

英文摘要：

Background: The growing role of multiparametric MRI (mpMRI) and MRI-targeted biopsy (MRI-TBx) suggests they may replace random systematic biopsy (SBx), specifically detection and subsequent treatment of clinically significant prostate cancer (csPCa). Objectives: To perform a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the detection rates (DR) of csPCa using MRI-TBx alone, SBx alone, or their combination in biopsy naïve patients suspected of having prostate cancer (PCa). Methods: PubMed, MEDLINE, Embase, and the Cochrane Library were searched up to 23 March 2023, for RCTs comparing PCa DR between biopsy strategies in patients with suspected prostate cancer. Detection rates were pooled using random/fixed effect models, and the study quality was assessed using the Cochrane risk of bias revised tool. Results: Ten RCTs (involving 3646 patients) were analysed, revealing that the combined biopsy method achieved higher overall csPCa DR compared to the SBx method alone (RR = 1.40 [95% CI = 1.15–1.71] and 1.47 [95% CI = 1.13–1.92], respectively). However, there was no significant difference in DR for clinically insignificant prostate cancer (ciPCa) between the two methods. Conclusions: This review concludes that MRI-TBx and SBx detect overall and clinically significant prostate cancer (csPCa) better than SBx alone. The variety of factors requires cautious interpretation, yet these findings are the strongest evidence. The combination technique is recommended for biopsy-naïve groups, but more study is needed to optimise execution and overcome uncertainties.

摘要翻译： 

背景：多参数磁共振成像（mpMRI）和磁共振成像靶向活检（MRI-TBx）的作用日益凸显，表明它们可能取代随机系统活检（SBx），特别是在临床显著性前列腺癌（csPCa）的检测和后续治疗方面。目的：对随机对照试验（RCTs）进行系统回顾和荟萃分析，比较在疑似前列腺癌（PCa）的初诊活检患者中，单独使用MRI-TBx、单独使用SBx或两者联合使用对csPCa的检出率（DR）。方法：检索截至2023年3月23日的PubMed、MEDLINE、Embase和Cochrane Library数据库，查找比较疑似前列腺癌患者不同活检策略间PCa检出率的随机对照试验。使用随机/固定效应模型汇总检出率，并使用Cochrane偏倚风险修订工具评估研究质量。结果：分析了10项随机对照试验（涉及3646名患者），结果显示，与单独使用SBx方法相比，联合活检方法获得了更高的总体csPCa检出率（风险比分别为RR = 1.40 [95% CI = 1.15–1.71] 和 1.47 [95% CI = 1.13–1.92]）。然而，两种方法在临床非显著性前列腺癌（ciPCa）的检出率方面无显著差异。结论：本综述得出结论，MRI-TBx与SBx联合使用比单独使用SBx能更好地检测总体前列腺癌和临床显著性前列腺癌（csPCa）。多种因素要求谨慎解读结果，但这些发现是目前最有力的证据。建议对初诊活检人群采用联合活检技术，但需要更多研究来优化操作并克服不确定性。

原文链接：

Identifying Optimal Prostate Biopsy Strategy for the Detection Rate of Clinically Significant Prostate Cancer: A Systematic Review and Meta-Analysis of Randomised Controlled Trials (RCTs) in Biopsy-Naïve Population