Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
J Urol. 2012 Apr;187(4):1247-52. doi: 10.1016/j.juro.2011.11.112. Epub 2012 Feb 14.
We report magnetic resonance imaging findings among unselected men with low risk prostate cancer before active surveillance.
We prospectively enrolled men with low grade, low risk, localized prostate cancer. All patients underwent multiparametric endorectal coil magnetic resonance imaging and were offered confirmatory biopsy within 1 year of imaging. The primary outcome was the impact of magnetic resonance imaging on identifying patients who were reclassified by confirmatory biopsy as no longer fulfilling active surveillance criteria. We further identified clinical parameters associated with reclassification. The cohort was stratified as patients with 1) normal magnetic resonance imaging, 2) cancer on magnetic resonance imaging concordant with initial biopsy (less than 1 cm) and 3) cancer on magnetic resonance imaging larger than 1 cm. We performed univariate analysis to assess differences in clinical parameters among the groups.
Magnetic resonance imaging did not detect cancer in 23 cases (38%) while magnetic resonance imaging and initial biopsy were concordant in 24 (40%). Magnetic resonance imaging detected a 1 cm or larger lesion in 13 patients (22%). Of the cases 18 (32.14%) were reclassified. When no cancer was identified on magnetic resonance imaging, only 2 cases (3.5%) were reclassified. The positive and negative predictive values for magnetic resonance imaging predicting reclassification were 83% (95% CI 73-93) and 81% (95% CI 71-91), respectively. Prostate specific antigen density was increased in patients with lesions larger than 1 cm on magnetic resonance imaging compared to those with no cancer on imaging (median 0.15 vs 0.07 ng/ml/cc, p=0.016).
Magnetic resonance imaging appears to have a high yield for predicting reclassification among men who elect active surveillance. Upon confirmation of our results magnetic resonance imaging may be used to better select and guide patients before active surveillance.
我们报告了在主动监测前，低危前列腺癌未选择男性的磁共振成像结果。
我们前瞻性地招募了低级别、低危、局限性前列腺癌患者。所有患者均接受多参数直肠内线圈磁共振成像检查，并在成像后 1 年内接受确认性活检。主要结局是磁共振成像对识别通过确认性活检重新分类为不再符合主动监测标准的患者的影响。我们进一步确定了与重新分类相关的临床参数。该队列分为以下三组：1）磁共振成像正常，2）磁共振成像与初始活检一致（小于 1cm），3）磁共振成像显示大于 1cm 的肿瘤。我们进行了单变量分析，以评估各组之间临床参数的差异。
磁共振成像在 23 例（38%）中未检测到癌症，而磁共振成像与初始活检一致的有 24 例（40%）。磁共振成像在 13 例患者中检测到 1cm 或更大的病变（22%）。18 例（32.14%）被重新分类。在磁共振成像未发现癌症的情况下，仅有 2 例（3.5%）被重新分类。磁共振成像预测重新分类的阳性和阴性预测值分别为 83%（95%CI73-93）和 81%（95%CI71-91）。与磁共振成像无癌症的患者相比，磁共振成像显示大于 1cm 病变的患者前列腺特异性抗原密度升高（中位数分别为 0.15 和 0.07ng/ml/cc，p=0.016）。
磁共振成像在选择主动监测的男性中似乎具有较高的预测重新分类的效果。在确认我们的结果后，磁共振成像可用于更好地选择和指导主动监测前的患者。
