Preliminary clinical practice of radical prostatectomy without preoperative biopsy.
10.1097/CM9.0000000000003204
- Author:
Ranlu LIU
1
;
Lu YIN
2
;
Shenfei MA
3
;
Feiya YANG
2
;
Zhenpeng LIAN
3
;
Mingshuai WANG
2
;
Ye LEI
2
;
Xiying DONG
2
;
Chen LIU
4
;
Dong CHEN
2
;
Sujun HAN
2
;
Yong XU
3
;
Nianzeng XING
2
Author Information
1. Department of Urology, Tianjin Medical University General Hospital, Tianjin 300052, China.
2. Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
3. Department of Urology & Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
4. Department of Nuclear Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Male;
Prostatectomy/methods*;
Prostatic Neoplasms/diagnosis*;
Middle Aged;
Aged;
Positron Emission Tomography Computed Tomography/methods*;
Biopsy;
Multiparametric Magnetic Resonance Imaging;
Prostate-Specific Antigen/metabolism*
- From:
Chinese Medical Journal
2025;138(6):721-728
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:At present, biopsy is essential for the diagnosis of prostate cancer (PCa) before radical prostatectomy (RP). However, with the development of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI), it might be feasible to avoid biopsy before RP. Herein, we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI.
METHODS:Between December 2017 and April 2022, 56 patients with maximum standardized uptake value (SUVmax) of ≥4 and Prostate Imaging Reporting and Data System (PI-RADS) ≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals. The consistency between clinical and pathological diagnoses was evaluated. Preoperative characteristics were compared among patients with different pathological types, T stages, International Society of Urological Pathology (ISUP) grades, and European Association of Urology (EAU) risk groups.
RESULTS:Fifty-five (98%) patients were confirmed with PCa by pathology, including 49 (89%) with clinically significant prostate cancer (csPCa, defined as ISUP grade ≥2 malignancy). One patient was diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN). CsPCa patients, compared with clinically insignificant prostate cancer (cisPCa) and HGPIN patients, were associated with a higher level of prostate-specific antigen (22.9 ng/mL vs . 10.0 ng/mL, P = 0.032), a lower median prostate volume (32.2 mL vs . 65.0 mL, P = 0.001), and a higher median SUVmax (13.3 vs . 5.6, P <0.001).
CONCLUSIONS:It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI. However, the diagnostic efficacy of csPCa with PI-RADS ≥4 and SUVmax of ≥4 is inadequate for performing a procedure such as RP. Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.
