Shin Toshitaka, Smyth Thomas B, Ukimura Osamu, Ahmadi Nariman, de Castro Abreu Andre Luis, Oishi Masakatsu, Mimata Hiromitsu, Gill Inderbir S
USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Urology, Oita University, Oita, Japan.
BJU Int. 2017 Aug;120(2):233-238. doi: 10.1111/bju.13786. Epub 2017 Feb 15.
To assess the diagnostic yield of targeted prostate biopsy in African-American (A-A) men using image fusion of multi-parametric magnetic resonance imaging (mpMRI) with real-time transrectal ultrasonography (US).
We retrospectively analysed 661 patients (117 A-A and 544 Caucasian) who had mpMRI before biopsy and then underwent MRI/US image-fusion targeted biopsy (FTB) between October 2012 and August 2015. The mpMRIs were reported on a 5-point Likert scale of suspicion. Clinically significant prostate cancer (CSPC) was defined as biopsy Gleason score ≥7.
After controlling for age, prostate-specific antigen level and prostate volume, there were no significant differences between A-A and Caucasian men in the detection rate of overall cancer (35.0% vs 34.2%, P = 0.9) and CSPC (18.8% vs 21.7%, P = 0.3) with MRI/US FTB. There were no significant differences between the races in the location of dominant lesions on mpMRI, and in the proportion of 5-point Likert scoring. In A-A men, MRI/US FTB from the grade 4-5 lesions outperformed random biopsy in the detection rate of overall cancer (70.6% vs 37.2%, P = 0.003) and CSPC (52.9% vs 12.4%, P < 0.001). MRI/US FTB outperformed random biopsy in cancer core length (5.0 vs 2.4 mm, P = 0.001), in cancer rate per core (24.9% vs 6.8%, P < 0.001), and in efficiency for detecting one patient with CSPC (mean number of cores needed 13.3 vs 81.9, P < 0.001), respectively.
Our key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI/US FTB between A-A and Caucasian men. MRI/US FTB detected more CSPC using fewer cores compared with random biopsy.
通过多参数磁共振成像（mpMRI）与实时经直肠超声检查（US）的图像融合，评估非洲裔美国（A - A）男性靶向前列腺活检的诊断率。
我们回顾性分析了661例患者（117例A - A男性和544例白种人男性），这些患者在活检前接受了mpMRI检查，并于2012年10月至2015年8月期间接受了MRI/US图像融合靶向活检（FTB）。mpMRI根据5分李克特怀疑量表进行报告。临床显著性前列腺癌（CSPC）定义为活检Gleason评分≥7分。
在控制年龄、前列腺特异性抗原水平和前列腺体积后，A - A男性和白种人男性在通过MRI/US FTB检测总体癌症（35.0%对34.2%，P = 0.9）和CSPC（18.8%对21.7%，P = 0.3）的检出率方面没有显著差异。在mpMRI上主要病变的位置以及5分李克特评分比例方面，不同种族之间没有显著差异。在A - A男性中，来自4 - 5级病变的MRI/US FTB在总体癌症（70.6%对37.2%，P = 0.003）和CSPC（52.9%对12.4%，P < 0.001）的检出率方面优于随机活检。MRI/US FTB在癌灶核心长度（5.0对2.4毫米，P = 0.001）、每个核心的癌症发生率（24.9%对6.8%，P < 0.001）以及检测一名CSPC患者的效率（所需核心的平均数量13.3对81.9，P < 0.001）方面均优于随机活检。
我们的主要发现证实，在A - A男性和白种人男性中，通过MRI/US FTB检测总体前列腺癌和CSPC的检出率不存在种族差异。与随机活检相比，MRI/US FTB使用更少的核心检测到更多的CSPC。
