目前，在根治性前列腺切除术（RP）之前，活检对于前列腺癌（PCa）的诊断至关重要。然而，随着前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（PSMA PET/CT）和多参数磁共振成像（mpMRI）的发展，在RP之前避免活检可能是可行的。在此，我们的目的是探讨在 PSMA PET/CT 和 mpMRI 评估后高度怀疑患有 PCa 的患者在 RP 前避免活检的可行性。 2017 年 12 月至 2022 年 4 月，最大标准化摄取值 (SUVmax) ≥ 4 的 56 名患者前列腺影像报告和数据系统（PI-RADS）≥4个病灶且未经术前活检而接受RP的患者纳入来自两家三级医院。评估临床和病理诊断之间的一致性。比较不同病理类型、T分期、国际泌尿病理学会（ISUP）分级和欧洲泌尿外科协会（EAU）危险组患者的术前特征。55例（98%）患者经病理证实为PCa，其中 49 例 (89%) 患有临床显着的前列腺癌（csPCa，定义为 ISUP ≥2 级恶性肿瘤）。一名患者被诊断患有高级别前列腺上皮内瘤变（HGPIN）。与临床上不显着的前列腺癌 (cisPCa) 和 HGPIN 患者相比，CsPCa 患者的前列腺特异性抗原水平较高（22.9 ng/mL vs. 10.0 ng/mL，P = 0.032），中位前列腺体积较低（ 32.2 mL vs. 65.0 mL，P = 0.001），以及较高的中位 SUVmax（13.3 vs. 5.6，P <0.001）。对于基于 PSMA PET/ 的 PCa 可能性较高的患者，在 RP 前避免活检可能是可行的CT 和 mMRI。然而，PI-RADS ≥ 4 且 SUVmax ≥ 4 的 csPCa 的诊断功效不足以执行 RP 等手术。有必要进行更大样本量的进一步前瞻性多中心研究，以证实我们的观点并利用 PSMA PET/CT 和 mpMRI 建立预测模型。版权所有 © 2024 中华医学会，由 Wolters Kluwer, Inc. 根据 CC-BY-NC-ND 制作执照。

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.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.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).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.Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.