Academic Unit of Radiotherapy and Oncology, Department of Radiology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK.
Eur Urol. 2009 Dec;56(6):981-7. doi: 10.1016/j.eururo.2008.11.051. Epub 2008 Dec 6.
Markers that predict the behaviour of localised prostate cancer are needed to identify patients that require treatment.
We have analysed the apparent diffusion coefficient (ADC) generated from diffusion-weighted magnetic resonance imaging (DW-MRI) with respect to repeat biopsy findings and time to radical treatment in patients in a prospective study of active surveillance.
DESIGN, SETTING, AND PARTICIPANTS: Some 86 men recruited between 2002 and 2006 were followed for a median of 29 mo. Patients had clinical stage T1/T2a N0/Nx M0/Mx adenocarcinoma of the prostate, prostate-specific antigen (PSA) level<15 ng/ml, Gleason score≤7, primary Gleason grade≤3, and positive biopsy cores (pbc)≤50%.
All patients had DW-MRI in addition to standard MRI sequences. Tumour regions of interest (ROIs) were identified using T2-weighted fast-spin echo images as focal areas of restricted diffusion. Univariate analyses including all clinical variables and tumour ADC data were performed with respect to repeat biopsy findings and time to radical treatment. Receiver operating curves (ROC) compared predictive variables.
Patients in the study had a median age of 66 yr and a median initial PSA level of 6.7 ng/ml. Some 39 patients (45%) received deferred radical treatment, and 34 patients (40%) had adverse histology on repeat biopsy. According to univariate analysis, tumour ADC was a significant predictor of both adverse repeat biopsy findings (p<0.0001; hazard ratio [HR]: 1.3; 95% confidence interval [CI]: 1.1-1.6), and time to radical treatment (p<0.0001; HR: 1.5; 95% CI: 1.2-1.8). ROC curves for ADC showed an area under the curve (AUC) of 0.7 for prediction of adverse repeat biopsy findings and an AUC of 0.83 for prediction of radical treatment.
In patients with low-risk, localised disease, tumour ADC on DW-MRI may be a useful marker of prostate cancer progression and may help to identify patients who stand to benefit from radical treatment. This possibility warrants further study.
需要能够预测局限性前列腺癌行为的标志物，以识别需要治疗的患者。
我们分析了扩散加权磁共振成像（DW-MRI）的表观扩散系数（ADC）与前瞻性主动监测研究中重复活检结果和根治性治疗时间的关系。
设计、地点和参与者：2002 年至 2006 年间招募的 86 名男性患者中位随访 29 个月。患者患有临床分期 T1/T2aN0/NxM0/Mx 前列腺腺癌，前列腺特异性抗原（PSA）<15ng/ml，Gleason 评分≤7，原发 Gleason 分级≤3，阳性活检核心（pbc）≤50%。
所有患者均进行 DW-MRI 检查，同时进行标准 MRI 序列检查。使用 T2 加权快速自旋回波图像识别肿瘤感兴趣区（ROI），作为弥散受限的局灶性区域。对所有临床变量和肿瘤 ADC 数据进行单变量分析，以评估重复活检结果和根治性治疗时间。接收者操作曲线（ROC）比较预测变量。
研究患者的中位年龄为 66 岁，中位初始 PSA 水平为 6.7ng/ml。39 名患者（45%）接受了延迟性根治性治疗，34 名患者（40%）在重复活检中发现了不良组织学。根据单变量分析，肿瘤 ADC 是不良重复活检结果（p<0.0001；危险比[HR]：1.3；95%置信区间[CI]：1.1-1.6）和根治性治疗时间（p<0.0001；HR：1.5；95% CI：1.2-1.8）的显著预测因子。ADC 的 ROC 曲线显示，预测不良重复活检结果的曲线下面积（AUC）为 0.7，预测根治性治疗的 AUC 为 0.83。
在低危局限性疾病患者中，DW-MRI 上的肿瘤 ADC 可能是前列腺癌进展的有用标志物，并有助于识别从根治性治疗中获益的患者。这一可能性需要进一步研究。
