University Medical Centre St Radboud, Nijmegen, The Netherlands.
J Urol. 2010 Feb;183(2):520-7. doi: 10.1016/j.juro.2009.10.022. Epub 2009 Dec 14.
Undetected cancer in repeat transrectal ultrasound guided prostate biopsies in patients with increased prostate specific antigen greater than 4 ng/ml is a considerable concern. We investigated the tumor detection rate of tumor suspicious regions on multimodal 3 Tesla magnetic resonance imaging and subsequent magnetic resonance imaging guided biopsy in 68 men with repeat negative transrectal ultrasound guided prostate biopsies. We compared results to those in a matched transrectal ultrasound guided prostate biopsy population. Also, we determined the clinical significance of detected tumors.
A total of 71 consecutive patients with prostate specific antigen greater than 4 ng/ml and 2 or greater negative transrectal ultrasound guided prostate biopsy sessions underwent multimodal 3 Tesla magnetic resonance imaging. In 68 patients this was followed by magnetic resonance imaging guided biopsy directed toward tumor suspicious regions. A matched multisession transrectal ultrasound guided prostate biopsy population from our institutional database was used for comparison. The clinical significance of detected tumors was established using accepted criteria, including prostate specific antigen, Gleason grade, stage and tumor volume.
The tumor detection rate of multimodal 3 Tesla magnetic resonance imaging guided biopsy was 59% (40 of 68 cases) using a median of 4 cores. The tumor detection rate was significantly higher than that of transrectal ultrasound guided prostate biopsy in all patient subgroups (p <0.01) except in those with prostate specific antigen greater than 20 ng/ml, prostate volume greater than 65 cc and prostate specific antigen density greater than 0.5 ng/ml/cc, in which similar rates were achieved. Of the 40 patients with identified tumors 37 (93%) were considered highly likely to harbor clinically significant disease.
Multimodal magnetic resonance imaging is an effective technique to localize prostate cancer. Magnetic resonance imaging guided biopsy of tumor suspicious regions is an accurate method to detect clinically significant prostate cancer in men with repeat negative biopsies and increased prostate specific antigen.
在前列腺特异性抗原（PSA）大于 4ng/ml 且重复经直肠超声引导前列腺活检结果为阴性的患者中，重复经直肠超声引导前列腺活检未检出的癌灶是一个值得关注的问题。我们研究了多模态 3.0T 磁共振成像（MRI）发现可疑肿瘤区域，并对其进行靶向活检，以提高重复经直肠超声引导前列腺活检阴性患者的肿瘤检出率。我们将研究结果与匹配的经直肠超声引导前列腺活检人群进行了比较。同时，我们还确定了检出肿瘤的临床意义。
连续 71 例 PSA 大于 4ng/ml 且重复经直肠超声引导前列腺活检次数大于 2 次的患者，进行多模态 3.0T MRI 检查。其中 68 例患者在 MRI 检查后，根据可疑肿瘤区域行 MRI 引导靶向活检。我们从医院数据库中选择了匹配的多程经直肠超声引导前列腺活检人群作为对照组。根据公认的标准，包括 PSA、Gleason 分级、分期和肿瘤体积，确定检出肿瘤的临床意义。
多模态 3.0T MRI 引导靶向活检的肿瘤检出率为 59%（68 例中有 40 例），平均活检 4 针。除 PSA 大于 20ng/ml、前列腺体积大于 65cc 和 PSA 密度大于 0.5ng/ml/cc 的患者外，多模态 MRI 引导靶向活检在所有患者亚组中的肿瘤检出率均显著高于经直肠超声引导前列腺活检（p＜0.01），而这部分患者的肿瘤检出率相似。在 40 例检出肿瘤的患者中，37 例（93%）被认为高度可能存在临床显著疾病。
多模态 MRI 是一种有效的前列腺癌定位技术。对可疑肿瘤区域行 MRI 引导靶向活检是提高重复经直肠超声引导前列腺活检阴性且 PSA 升高患者检出临床显著前列腺癌的有效方法。
