Chen Jie, Yi Xiao-Lei, Jiang Li-Xin, Wang Ren, Zhao Jun-Gong, Li Yue-Hua, Hu Bing
Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China.
Department of Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China.
Exp Ther Med. 2015 Jan;9(1):207-212. doi: 10.3892/etm.2014.2061. Epub 2014 Nov 11.
The detection rate of prostate cancer (PCa) using traditional biopsy guided by transrectal ultrasound (TRUS) is not satisfactory. The aim of this study was to determine the utility of 3-Tesla (3-T) magnetic resonance imaging (MRI) prior to TRUS-guided prostate biopsy and to investigate which subgroup of patients had the most evident improvement in PCa detection rate. A total of 420 patients underwent 3-T MRI examination prior to the first prostate biopsy and the positions of suspicious areas were recorded respectively. TRUS-guided biopsy regimes included systematic 12-core biopsy and targeted biopsy identified by MRI. Patients were divided into subgroups according to their serum prostate-specific antigen (PSA) levels, PSA density (PSAD), prostate volume, TRUS findings and digital rectal examination (DRE) findings. The ability of MRI to improve the cancer detection rate was evaluated. The biopsy positive rate of PCa was 41.2% (173/420), and 41 of the 173 (23.7%) patients were detected only by targeted biopsy in the MRI-suspicious area. Compared with the systematic biopsy, the positive rate was significantly improved by the additional targeted biopsy (P=0.0033). The highest improvement of detection rate was observed in patients with a PSA level of 4-10 ng/ml, PSAD of 0.12-0.20 ng/ml, prostate volume >50 ml, negative TRUS findings and negative DRE findings (P<0.05). Therefore, it is considered that 3-T MRI examination could improve the PCa detection rate on first biopsy, particularly in patients with a PSA level of 4-10 ng/ml, PSAD of 0.12-0.20 ng/ml, prostate volume of >50 ml, negative TRUS findings and negative DRE findings.
使用经直肠超声（TRUS）引导的传统活检方式检测前列腺癌（PCa）的检出率并不理想。本研究的目的是确定在TRUS引导的前列腺活检之前进行3特斯拉（3-T）磁共振成像（MRI）的效用，并调查哪类亚组患者的PCa检出率有最明显的提高。共有420例患者在首次前列腺活检前接受了3-T MRI检查，并分别记录了可疑区域的位置。TRUS引导的活检方案包括系统的12针活检和由MRI确定的靶向活检。根据患者的血清前列腺特异性抗原（PSA）水平、PSA密度（PSAD）、前列腺体积、TRUS检查结果和直肠指检（DRE）结果将患者分为亚组。评估了MRI提高癌症检出率的能力。PCa的活检阳性率为41.2%（173/420），173例（23.7%）患者中41例仅在MRI可疑区域通过靶向活检被检测出。与系统活检相比，额外的靶向活检使阳性率显著提高（P=0.0033）。在PSA水平为4-10 ng/ml、PSAD为0.12-0.20 ng/ml、前列腺体积>50 ml、TRUS检查结果为阴性且DRE检查结果为阴性的患者中观察到最高的检出率提高（P<0.05）。因此，认为3-T MRI检查可提高首次活检时的PCa检出率，特别是在PSA水平为4-10 ng/ml, PSAD为0.12-0.20 ng/ml, 前列腺体积>50 ml, TRUS检查结果为阴性且DRE检查结果为阴性的患者中。
