在先前标准活检为阴性后，基于磁共振成像/超声融合软件的靶向前列腺活检中，高前列腺癌基因3（PCA3）评分与前列腺影像报告和数据系统（PI-RADS）分级升高及活检 Gleason评分相关。

High prostate cancer gene 3 (PCA3) scores are associated with elevated Prostate Imaging Reporting and Data System (PI-RADS) grade and biopsy Gleason score, at magnetic resonance imaging/ultrasonography fusion software-based targeted prostate biopsy after a previous negative standard biopsy.

作者信息

De Luca Stefano, Passera Roberto, Cattaneo Giovanni, Manfredi Matteo, Mele Fabrizio, Fiori Cristian, Bollito Enrico, Cirillo Stefano, Porpiglia Francesco

机构信息

Department of Urology, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Italy.

Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Torino, Torino, Italy.

出版信息

BJU Int. 2016 Nov;118(5):723-730. doi: 10.1111/bju.13504. Epub 2016 May 24.

DOI:10.1111/bju.13504

PMID:27112799

Abstract

OBJECTIVE

To determine the association among prostate cancer gene 3 (PCA3) score, Prostate Imaging Reporting and Data System (PI-RADS) grade and Gleason score, in a cohort of patients with elevated prostate-specific antigen (PSA), undergoing magnetic resonance imaging/ultrasonography fusion software-based targeted prostate biopsy (TBx) after a previous negative randomised 'standard' biopsy (SBx).

PATIENTS AND METHODS

In all, 282 patients who underwent TBx after previous negative SBx and a PCA3 urine assay, were enrolled. The associations between PCA3 score/PI-RADS and PCA3 score/Gleason score were investigated by K-means clustering, a receiver operating characteristic analysis and binary logistic regression.

RESULTS

The PCA3 score difference for the negative vs positive TBx cohorts was highly statistically significant. A 1-unit increase in the PCA3 score was associated to a 2.4% increased risk of having a positive TBx result. A PCA3 score of >80 and a PI-RADS grade of ≥4 were independent predictors of a positive TBx. The association between the PCA3 score and PI-RADS grade was statistically significant (the median PCA3 score for PI-RADS grade groups 3, 4, and 5 was 58, 104, and 146, respectively; P = 0.006). A similar pattern was detected for the relationship between the PCA3 score and Gleason score; an increasing PCA3 score was associated with a worsening Gleason score (median PCA3 score equal to 62, 105, 132, 153, 203, and 322 for Gleason Score 3+4, 4+3, 4+4, 4+5, 5+4, and 5+5, respectively; P < 0.001).

CONCLUSION

TBx improved PCA3 score diagnostic and prognostic performance for prostate cancer. The PCA3 score was directly associated both with biopsy Gleason score and PI-RADS grade: notably, in the 'indeterminate' PI-RADS grade 3 subgroup.

摘要

目的

在一组前列腺特异性抗原（PSA）升高、先前随机“标准”活检（SBx）结果为阴性后接受基于磁共振成像/超声融合软件的靶向前列腺活检（TBx）的患者中，确定前列腺癌基因3（PCA3）评分、前列腺影像报告和数据系统（PI-RADS）分级与Gleason评分之间的关联。

患者与方法

总共纳入282例先前SBx结果为阴性且进行了PCA3尿液检测后接受TBx的患者。通过K均值聚类、受试者工作特征分析和二元逻辑回归研究PCA3评分/PI-RADS以及PCA3评分/Gleason评分之间的关联。

结果

阴性与阳性TBx队列的PCA3评分差异具有高度统计学意义。PCA3评分每增加1个单位，TBx结果为阳性的风险增加2.4%。PCA3评分>80和PI-RADS分级≥4是TBx结果为阳性的独立预测因素。PCA3评分与PI-RADS分级之间的关联具有统计学意义（PI-RADS分级3、4和5组的PCA3评分中位数分别为58、104和146；P = 0.006）。PCA3评分与Gleason评分之间的关系也呈现类似模式；PCA3评分增加与Gleason评分恶化相关（Gleason评分3+4、4+3、4+4、4+5、5+4和5+5对应的PCA3评分中位数分别为62、105、132、153、203和322；P < 0.001）。