前列腺活检的病理分级遵循国际泌尿病理学会 (ISUP) 最高分级组 (GG) 的规则。这个规则是在系统活检 (SBx) 时代开发的，在前列腺的非常不同区域采样时是有意义的。对于多参数磁共振成像靶向活检 (mpMRI-TBx)，这个规则被保留下来，其中多个样本都是从小的区域进行靶向和系统性采样。尤其是当SBx和mpMRI-TBx 的结果不一致时，患者被分配为较高的GG。然而，当mpMRI-TBx和SBx的分级不一致时，最合适的分级还没有经过实证研究。尚不存在具有较长肿瘤学随访的SBx和mpMRI-TBx联合活检病人队列。为了估计每种活检和病理分级组合的复发风险，我们使用了根治性前列腺切除术 (RP) 上的GG作为mpMRI-TBx GG的替代。我们分析了在三级转诊中心接受SBx和RP的12,468名男性的数据，并评估了每一对活检和手术GG结果的5年生化复发无病生存率 (bRFS)。我们发现，在SBx和RP分级不一致的病例中，复发风险是中间的，无论是RP还是SBx的最高分级。例如，GG 3在RP上的男性的5年bRFS率为57%，GG 3在SBx上的男性为60%，但RP GG 3和SBx GG 2的男性为63%，RP GG 2和SBx GG 3的男性为79%。将这些结果应用于mpMRI-TBx对当前分级实践产生了怀疑：当SBx和mpMRI-TBx之间的GG不一致时，生化复发的风险不是由最高分级决定，而是介于两个分级之间的中间分级。我们的研究结果应该激励对同时进行mpMRI-TBx和SBx的病人进行长期结果评估的研究，以实证评估当前的分级实践。患者总结：前列腺癌患者可能接受两种活检类型：(1)系统活检，以模板为基础进行采样；(2)靶向活检，从扫描中检测到的病变进行采样。两种方法鉴定的前列腺癌分级可能存在差异。在这种情况下，癌症复发的风险似乎由介于较低和较高分级之间的中级分级预测。版权所有 © 2023 欧洲泌尿学会。由Elsevier B.V.出版。版权所有。

Pathology grading of prostate biopsy follows the rule that the highest International Society of Urological Pathology grade group (GG) is the GG assigned. This rule was developed in the systematic biopsy (SBx) era and makes sense when samples are from very different areas of the prostate. This rule has been kept for multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (MRI-TBx), for which multiple samples-targeted and systematic-are taken from small areas. In particular, if the results for SBx and MRI-TBx are discordant, the patient is assigned the higher GG. However, the most appropriate grading when MRI-TBx and SBx grades are discordant has never been investigated empirically. A cohort of patients who have undergone SBx and MRI-TBx with long oncological follow-up does not yet exist. To estimate the risk of recurrence for every combination of biopsy and pathological grades, we used the GG on radical prostatectomy (RP) as a surrogate for GG on MRI-TBx GG surrogate. We analyzed data for 12 468 men who underwent SBx and RP at a tertiary referral center and assessed 5-yr biochemical recurrence-free survival (bRFS) for each pairwise combination of biopsy and surgical GG results. We found that for cases with discordant SBx and RP grades, the risk of recurrence was intermediate, irrespective of whether the highest grade was at RP or SBx. For instance, the 5-yr bRFS rate was 57% for men with GG 3 on RP and 60% for men with GG 3 on SBx, but 63% for men with RP GG 3 and SBx GG 2, and 79% for men with RP GG 2 and SBx GG 3. Translating these findings to MRI-TBx casts doubt on current grading practice: when GGs are discordant between SBx and MRI-TBx, the risk of biochemical recurrence risk is not driven by the highest grade but by an intermediate between the two grades. Our findings should motivate studies assessing long-term outcomes for patients undergoing both MRI-TBx and SBx with a view to empirically evaluating current grading practices. PATIENT SUMMARY: Patients with prostate cancer may undergo two biopsy types: (1) systematic biopsy, for which sampling follows a systematic template; and (2) targeted biopsy, for which samples are taken from lesions detected on scans. There may be a difference in prostate cancer grade identified by the two approaches. In such cases, the risk of cancer recurrence seems to be predicted by an intermediate grade between the lower and higher grades.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.