核磁共振成像（MRI）指引的前列腺活检（MRI-biopsy）可检测到系统活检（S-biopsy）未发现的高分级（GG）前列腺癌。然而，对于MRI-biopsy和S-biopsy所检测到的癌症，在评估是否具有等效的肿瘤学风险方面存在疑问。 作者评估了MRI-biopsy和S-biopsy所诊断GG的相对肿瘤学风险。本研究是一项回顾性分析，对Memorial Sloan Kettering癌症中心在2014年至2022年期间进行前列腺切除术的所有同时进行MRI-biopsy和S-biopsy的患者进行评估。使用三个Logistic回归模型，以不良病理学为主要结果（4级原发模式，任何5级模式，精囊浸润或淋巴结受累）。第一个模型包括术前前列腺特异性抗原水平、阳性和阴性S-biopsy核心的数量、S-biopsy GG和MRI-biopsy GG。第二个模型排除了MRI-biopsy GG，得到基于S-biopsy GG的平均风险。第三个模型排除了S-biopsy GG，得到基于MRI-biopsy GG的风险。使用Cox回归进行二次分析，评估了生化复发的12个月风险。总共确定了991名患者，其中包括359名（36%）存在不良病理学结果。相较于仅S-biopsy GG，MRI-biopsy GG对肿瘤学风险产生了影响（p < 0.001）。然而，如果两次活检的分级不一致，则风险处于两个分级之间。例如，对于S-biopsy GG为GG2和GG3的患者，进展性病理学的平均风险分别为19%和66%，而对于S-biopsy GG为GG2和MRI-biopsy GG为GG3的患者，平均风险为47%。生化复发12个月的相应估计分别为5.8%、15%和10%。当前的发现对基于最高GG确定风险组的实践提出了疑问。因为治疗算法在很大程度上依赖于GG，所以迫切需要进一步研究，以评估前列腺肿瘤的肿瘤学风险与检测技术的关系。 利用核磁共振成像（MRI）辅助诊断前列腺癌有助于检测出更多高级别癌症，而不仅仅依赖于系统活检。然而，我们不知道通过MRI诊断出的高级别癌症是否对患者的危险性与通过系统活检诊断出的高级别癌症相同。我们检查了所有接受过MRI活检和系统活检后进行前列腺切除的患者，以确定这些患者是否存在侵袭性癌症的危险因素和迹象（癌症是否扩散到前列腺外部或者是非常高级别的癌症）。我们发现，如果系统活检和MRI指引活检之间存在分级差异，则侵袭性癌症的风险处于两个分级之间。© 2023 American Cancer Society.

Magnetic resonance imaging (MRI)-targeted prostate biopsy (MRI-biopsy) detects high-Grade Group (GG) prostate cancers not identified by systematic biopsy (S-biopsy). However, questions have been raised whether cancers detected by MRI-biopsy and S-biopsy, grade-for-grade, are of equivalent oncologic risk. The authors evaluated the relative oncologic risk of GG diagnosed by S-biopsy and MRI-biopsy.This was a retrospective analysis of all patients who had both MRI-biopsy and S-biopsy and underwent with prostatectomy (2014-2022) at Memorial Sloan Kettering Cancer Center. Three logistic regression models were used with adverse pathology as the primary outcome (primary pattern 4, any pattern 5, seminal vesicle invasion, or lymph node involvement). The first model included the presurgery prostate-specific antigen level, the number of positive and negative S-biopsy cores, S-biopsy GG, and MRI-biopsy GG. The second model excluded MRI-biopsy GG to obtain the average risk based on S-biopsy GG. The third model excluded S-biopsy GG to obtain the risk based on MRI-biopsy GG. A secondary analysis using Cox regression evaluated the 12-month risk of biochemical recurrence.In total, 991 patients were identified, including 359 (36%) who had adverse pathology. MRI-biopsy GG influenced oncologic risk compared with S-biopsy GG alone (p < .001). However, if grade was discordant between biopsies, then the risk was intermediate between grades. For example, the average risk of advanced pathology for patients who had GG2 and GG3 on S-biopsy was 19% and 66%, respectively, but the average risk was 47% for patients who had GG2 on S-biopsy and patients who had GG3 on MRI-biopsy. The equivalent estimates for 12-month biochemical recurrence were 5.8%, 15%, and 10%, respectively.The current findings cast doubt on the practice of defining risk group based on the highest GG. Because treatment algorithms depend fundamentally on GG, further research is urgently required to assess the oncologic risk of prostate tumors depending on detection technique.Using magnetic resonance imaging (MRI) to help diagnose prostate cancer can help identify more high-grade cancers than using a systematic template biopsy alone. However, we do not know if high-grade cancers diagnosed with the help of an MRI are as dangerous to the patient as high-grade cancers diagnosed with a systematic biopsy. We examined all of our patients who had an MRI biopsy and a systematic biopsy and then had their prostates removed to find out if these patients had risk factors and signs of aggressive cancer (cancer that spread outside the prostate or was very high grade). We found that, if there was a difference in grade between the systematic biopsy and the MRI-targeted biopsy, the risk of aggressive cancer was between the two grades.© 2023 American Cancer Society.