Washino Satoshi, Okochi Tomohisa, Saito Kimitoshi, Konishi Tsuzumi, Hirai Masaru, Kobayashi Yutaka, Miyagawa Tomoaki
Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
BJU Int. 2017 Feb;119(2):225-233. doi: 10.1111/bju.13465. Epub 2016 Apr 1.
To assess the value of the Prostate Imaging Reporting and Data System (PI-RADS) scoring system, for prostate multi-parametric magnetic resonance imaging (mpMRI) to detect prostate cancer, and classical parameters, such as prostate-specific antigen (PSA) level, prostate volume and PSA density, for predicting biopsy outcome in biopsy naïve patients who have suspected prostate cancer.
Patients who underwent mpMRI at our hospital, and who had their first prostate biopsy between July 2010 and April 2014, were analysed retrospectively. The prostate biopsies were taken transperineally under transrectal ultrasonography guidance. In all, 14 cores were biopsied as a systematic biopsy in all patients. Two cognitive fusion-targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI-RADS scoring system version 2.0 (PI-RADS v2) was used to describe the MRI findings. Univariate and multivariate analyses were performed to determine significant predictors of prostate cancer and clinically significant prostate cancer.
In all, 288 patients were analysed. The median patient age, PSA level, prostate volume and PSA density were 69 years, 7.5 ng/mL, 28.7 mL, and 0.26 ng/mL/mL, respectively. The biopsy results were benign, clinically insignificant, and clinically significant prostate cancer in 129 (45%), 18 (6%) and 141 (49%) patients, respectively. The multivariate analysis revealed that PI-RADS v2 score and PSA density were independent predictors for prostate cancer and clinically significant prostate cancer. When PI-RADS v2 score and PSA density were combined, a PI-RADS v2 score of ≥4 and PSA density ≥0.15 ng/mL/mL, or PI-RADS v2 score of 3 and PSA density of ≥0.30 ng/mL/mL, was associated with the highest clinically significant prostate cancer detection rates (76-97%) on the first biopsy. Of the patients in this group with negative biopsy results, 22% were subsequently diagnosed as prostate cancer. In contrast, a PI-RADS v2 score of ≤3 and PSA density of <0.15 ng/mL/mL yielded no clinically significant prostate cancer and no additional detection of prostate cancer on further biopsies.
A combination of PI-RADS v2 score and PSA density can help in the decision-making process before prostate biopsy and in the follow-up strategy in biopsy naïve patients. Patients with a PI-RADS v2 score of ≤3 and PSA density of <0.15 ng/mL/mL may avoid unnecessary biopsies.
评估前列腺影像报告和数据系统（PI-RADS）评分系统在前列腺多参数磁共振成像（mpMRI）检测前列腺癌中的价值，以及经典参数如前列腺特异性抗原（PSA）水平、前列腺体积和PSA密度在预测初诊疑似前列腺癌患者活检结果中的价值。
回顾性分析2010年7月至2014年4月期间在我院接受mpMRI检查且首次进行前列腺活检的患者。前列腺活检在经直肠超声引导下经会阴进行。所有患者均系统活检14针。mpMRI上有可疑或不确定病变的患者，每个病变额外增加2针认知融合靶向活检。采用PI-RADS评分系统2.0版（PI-RADS v2）描述MRI表现。进行单因素和多因素分析以确定前列腺癌和临床显著前列腺癌的显著预测因素。
共分析288例患者。患者年龄中位数、PSA水平、前列腺体积和PSA密度分别为69岁、7.5 ng/mL、28.7 mL和0.26 ng/mL/mL。活检结果显示，129例（45%）患者为良性，18例（6%）为临床意义不显著的前列腺癌，141例（49%）为临床意义显著的前列腺癌。多因素分析显示，PI-RADS v2评分和PSA密度是前列腺癌和临床意义显著前列腺癌的独立预测因素。当PI-RADS v2评分和PSA密度联合使用时，PI-RADS v2评分≥4且PSA密度≥0.15 ng/mL/mL，或PI-RADS v2评分为3且PSA密度≥0.30 ng/mL/mL，与首次活检时临床意义显著前列腺癌的最高检出率（76 - 97%）相关。该组活检结果为阴性的患者中，22%随后被诊断为前列腺癌。相比之下，PI-RADS v2评分≤3且PSA密度<0.15 ng/mL/mL的患者未发现临床意义显著的前列腺癌，再次活检也未额外检出前列腺癌。
PI-RADS v2评分和PSA密度相结合有助于初诊患者前列腺活检前的决策过程及后续随访策略制定。PI-RADS v2评分≤3且PSA密度<0.15 ng/mL/mL的患者可避免不必要的活检。
