Department of Radiological Sciences, Sapienza Rome University Policlinico Umberto I, Rome, Italy.
Anticancer Res. 2011 Apr;31(4):1399-405.
To compare the prostate antigen 3 (PCA3) test with (1)H-magnetic resonance spectroscopic imaging ((1)H-MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCEMR) combined examination in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen (PSA) levels and prior negative random transrectal ultrasound (TRUS)-guided biopsy.
Forty-three patients with a first random biopsy negative for prostate adenocarcinoma, persistent elevated PSA and negative digital rectal examination were recruited. All the patients were submitted to MRSI examination (MRSI-DCEMR) and were submitted to an attentive prostate massage in order to perform PCA3 assay. Afterwards, 10-core laterally-directed random TRUS-guided prostate biopsy was performed.
The overall sensitivity and specificity of a PCA3 score ≥35 for positive biopsy were 76.9% and 66.6%, respectively, with a positive predictive value (PPV) of 80% and a negative predictive value (NPV) of 62.5%; as for MRSI sensitivity and specificity were, respectively, 92.8% and 86.6% with a PPV of 92.8% and a NPV of 86.6%. Receiver operating characteristic (ROC) analysis rates were 0.755 for PCA3 and 0.864 for MRSI.
Combined MRSI/DCEMR can better improve the cancer detection rate in patients with prior negative TRUS-guided biopsy and altered PSA serum levels than PCA3. Optimization of MRSI will allow more precise diagnosis of local invasion and improved bioptical procedures.
比较前列腺抗原 3（PCA3）检测与（1）H 磁共振波谱成像（（1）H-MRSI）和动态对比增强磁共振成像（DCEMR）联合检查在检测持续升高前列腺特异性抗原（PSA）水平且先前经直肠超声（TRUS）引导活检阴性的前列腺肿瘤病灶中的作用。
招募了 43 名首次经直肠超声引导活检未发现前列腺腺癌、PSA 持续升高且直肠指检阴性的患者。所有患者均接受 MRSI 检查（MRSI-DCEMR）和经肛门前列腺按摩以进行 PCA3 检测。随后，进行 10 针外侧定向随机 TRUS 引导前列腺活检。
PCA3 评分≥35 对阳性活检的总体敏感性和特异性分别为 76.9%和 66.6%，阳性预测值（PPV）为 80%，阴性预测值（NPV）为 62.5%；MRSI 的敏感性和特异性分别为 92.8%和 86.6%，PPV 为 92.8%，NPV 为 86.6%。受试者工作特征（ROC）分析结果显示，PCA3 的曲线下面积（AUC）为 0.755，MRSI 的 AUC 为 0.864。
与 PCA3 相比，联合 MRSI/DCEMR 可更好地提高先前经 TRUS 引导活检和 PSA 血清水平改变的患者的癌症检出率。MRSI 的优化将允许更精确地诊断局部侵犯并改善活检程序。
