Walton Diaz Annerleim, Shakir Nabeel Ahmad, George Arvin K, Rais-Bahrami Soroush, Turkbey Baris, Rothwax Jason T, Stamatakis Lambros, Hong Cheng William, Siddiqui Mohummad Minhaj, Okoro Chinonyerem, Raskolnikov Dima, Su Daniel, Shih Joanna, Han Hui, Parnes Howard L, Merino Maria J, Simon Richard M, Wood Bradford J, Choyke Peter L, Pinto Peter A
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Urol Oncol. 2015 May;33(5):202.e1-202.e7. doi: 10.1016/j.urolonc.2015.01.023. Epub 2015 Mar 6.
We evaluated the performance of multiparametric prostate magnetic resonance imaging (mp-MRI) and MRI/transrectal ultrasound (TRUS) fusion-guided biopsy (FB) for monitoring patients with prostate cancer on active surveillance (AS).
Patients undergoing mp-MRI and FB of target lesions identified on mp-MRI between August 2007 and August 2014 were reviewed. Patients meeting AS criteria (Clinical stage T1c, Gleason grade ≤ 6, prostate-specific antigen density ≤ 0.15, tumor involving ≤ 2 cores, and ≤ 50% involvement of any single core) based on extended sextant 12-core TRUS biopsy (systematic biopsy [SB]) were included. They were followed with subsequent 12-core biopsy as well as mp-MRI and MRI/TRUS fusion biopsy at follow-up visits until Gleason score progression (Gleason ≥ 7 in either 12-core or MRI/TRUS fusion biopsy). We evaluated whether progression seen on mp-MRI (defined as an increase in suspicion level, largest lesion diameter, or number of lesions) was predictive of Gleason score progression.
Of 152 patients meeting AS criteria on initial SB (mean age of 61.4 years and mean prostate-specific antigen level of 5.26 ng/ml), 34 (22.4%) had Gleason score ≥ 7 on confirmatory SB/FB. Of the 118 remaining patients, 58 chose AS and had at least 1 subsequent mp-MRI with SB/FB (median follow-up = 16.1 months). Gleason progression was subsequently documented in 17 (29%) of these men, in all cases to Gleason 3+4. The positive predictive value and negative predictive value of mp-MRI for Gleason progression was 53% (95% CI: 28%-77%) and 80% (95% CI: 65%-91%), respectively. The sensitivity and specificity of mp-MRI for increase in Gleason were also 53% and 80%, respectively. The number needed to biopsy to detect 1 Gleason progression was 8.74 for SB vs. 2.9 for FB.
Stable findings on mp-MRI are associated with Gleason score stability. mp-MRI appears promising as a useful aid for reducing the number of biopsies in the management of patients on AS. A prospective evaluation of mp-MRI as a screen to reduce biopsies in the follow-up of men on AS appears warranted.
我们评估了多参数前列腺磁共振成像（mp-MRI）以及MRI/经直肠超声（TRUS）融合引导活检（FB）在监测接受主动监测（AS）的前列腺癌患者中的性能。
回顾了2007年8月至2014年8月期间接受mp-MRI检查以及对mp-MRI上识别出的目标病变进行FB的患者。纳入基于扩展六分区12针TRUS活检（系统活检[SB]）符合AS标准（临床分期T1c，Gleason分级≤6，前列腺特异性抗原密度≤0.15，肿瘤累及≤2针，且任何单针累及≤50%）的患者。在后续随访中对他们进行12针活检以及mp-MRI和MRI/TRUS融合活检，直至Gleason评分进展（12针活检或MRI/TRUS融合活检中Gleason≥7）。我们评估了mp-MRI上所见的进展（定义为可疑程度增加、最大病变直径增加或病变数量增加）是否可预测Gleason评分进展。
在初始SB时符合AS标准的152例患者（平均年龄61.4岁，平均前列腺特异性抗原水平5.26 ng/ml）中，34例（22.4%）在确认性SB/FB时Gleason评分≥7。在其余118例患者中，58例选择AS并至少进行了1次后续的mp-MRI及SB/FB（中位随访时间 = 16.1个月）。这些男性中有17例（29%）随后记录到Gleason进展，所有病例均进展为Gleason 3+4。mp-MRI对Gleason进展的阳性预测值和阴性预测值分别为53%（95%CI：28%-77%）和80%（95%CI：65%-91%）。mp-MRI对Gleason增加的敏感性和特异性也分别为53%和80%。检测1例Gleason进展所需的SB活检次数为8.74次，而FB活检次数为2.9次。
mp-MRI上的稳定表现与Gleason评分稳定相关。mp-MRI似乎有望成为减少AS患者管理中活检次数的有用辅助手段。对mp-MRI作为减少AS男性随访中活检的筛查方法进行前瞻性评估似乎是必要的。
