我们研究了临床因素与活检格里森分级组 (GGG) 患者根治性前列腺切除术后未取样高危前列腺癌 (PC) 的存在以及 PC 特异性死亡率 (PCSM) 和全因死亡率 (ACM) 之间的关系。 ) 1 PC。研究人群包括 10228 名接受 GGG1 PC 治疗的患者，这些患者通过经直肠超声 (TRUS) 引导的系统活检 (SBx；n = 9248) 或联合活检 (CBx；SBx TRUS/磁共振图像 [MRI] 融合活检；n = 9248) 进行诊断； n = 980）来自德国汉堡一所大学医院的队列研究。我们使用logistic、Fine and Grays和Cox多变量回归方法来计算不良病理的调整优势比（aOR）和早期前列腺特异性抗原（PSA）失败（≤18个月）、PCSM、和与每个临床因素相关的 ACM。无论采用何种活检方法，活检阳性百分比 (PPB) > 50% 和 PSA > 20 ng/ml 与较高的不良病理风险显着相关（SBx：aOR 1.71 和 3.49；CBx：aOR分别为 1.81 和 2.82）和早期 PSA 失败（SBx：aHR 分别为 1.54 和 4.37；CBx：aHR 分别为 2.88 和 7.81）。在 SBx 组中，PPB > 50% 和 PSA > 20 ng/ml 也与 PCSM（aHR 2.56 和 3.71）和 ACM（aHR 1.47 和 2.00）的较高风险相关（所有 p ≤ 0.04）。该研究受到单机构队列设计的限制。对 GGG1 且 PPB > 50% 或 PSA > 20 ng/ml 的患者维持“癌症”分类，并考虑重新活检以识别未采样的高级疾病，可以最大限度地降低癌症风险对于接受非靶向前列腺活检的患者，大约十二分之一的活检结果为 1 级前列腺癌的患者可能患有比结果显示的更具侵袭性的癌症。非常高的 PSA（前列腺特异性抗原）水平 (>20 ng/ml) 或超过 50% 的活检样本中存在 1 级癌症，可以识别处于危险中的患者。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

We investigated the association of clinical factors at presentation with the presence of unsampled high-risk prostate cancer (PC) and PC-specific mortality (PCSM) and all-cause mortality (ACM) following radical prostatectomy in patients with biopsy Gleason Grade Group (GGG) 1 PC.The study population comprised 10228 patients treated for GGG1 PC diagnosed via transrectal ultrasound (TRUS)-guided systematic biopsy (SBx; n = 9248) or combined biopsy (CBx; SBx + TRUS/magnetic resonance image [MRI] fusion biopsy; n = 980) from a cohort study at a university hospital in Hamburg, Germany. We used logistic, Fine and Grays, and Cox multivariable regression methods to calculate the adjusted odds ratio (aOR) of adverse pathology and adjusted hazard ratios (aHRs) for early prostate-specific antigen (PSA) failure (≤18 mo), PCSM, and ACM in relation to each clinical factor.Irrespective of biopsy approach, percent positive biopsies (PPB) >50% and PSA >20 ng/ml were significantly associated with higher risk of adverse pathology (SBx: aOR 1.71 and 3.49; CBx: aOR 1.81 and 2.82, respectively) and early PSA failure (SBx: aHR 1.54 and 4.37; CBx: aHR 2.88 and 7.81, respectively). PPB >50% and PSA >20 ng/ml were also associated with higher risk of PCSM (aHRs 2.56 and 3.71) and ACM (aHRs 1.47 and 2.00) in the SBx group (all p ≤ 0.04). The study is limited by the single-institution cohort design.Maintaining the "cancer" classification for patients with GGG1 and either PPB >50% or PSA>20 ng/ml and considering rebiopsy to identify unsampled high-grade disease may minimize the risk of mortality for this subgroup.For patients undergoing non-targeted prostate biopsy, approximately 1 in 12 with a biopsy result of grade group 1 prostate cancer may have more aggressive cancer than the result suggests. A very high PSA (prostate-specific antigen) level (>20 ng/ml) or the presence of grade group 1 cancer in more than 50% of the biopsy samples can identify patients at risk.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.