Reed Aaron, Valle Luca F, Shankavaram Uma, Krauze Andra, Kaushal Aradhana, Schott Erica, Cooley-Zgela Theresa, Wood Bradford, Pinto Peter, Choyke Peter, Turkbey Baris, Citrin Deborah E
Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.
Int J Radiat Oncol Biol Phys. 2017 Apr 1;97(5):947-951. doi: 10.1016/j.ijrobp.2016.12.016. Epub 2016 Dec 18.
Targeted magnetic resonance imaging (MRI)/ultrasound fusion prostate biopsy (MRI-Bx) has recently been compared with the standard of care extended sextant ultrasound-guided prostate biopsy (SOC-Bx), with the former associated with an increased rate of detection of clinically significant prostate cancer. The present study sought to determine the influence of MRI-Bx on radiation therapy and androgen deprivation therapy (ADT) recommendations.
All patients who had received radiation treatment and had undergone SOC-Bx and MRI-Bx at our institution were included. Using the clinical T stage, pretreatment prostate-specific antigen, and Gleason score, patients were categorized into National Comprehensive Cancer Network risk groups and radiation treatment or ADT recommendations assigned. Intensification of the recommended treatment after multiparametric MRI, SOC-Bx, and MRI-Bx was evaluated.
From January 2008 to January 2016, 73 patients received radiation therapy at our institution after undergoing a simultaneous SOC-Bx and MRI-Bx (n=47 with previous SOC-Bx). Repeat SOC-Bx and MRI-Bx resulted in frequent upgrading compared with previous SOC-Bx (Gleason score 7, 6.7% vs 44.6%; P<.001; Gleason score 8-10, 2.1% vs 38%; P<.001). MRI-Bx increased the proportion of patients classified as very high risk from 24.7% to 41.1% (P=.027). Compared with SOC-Bx alone, including the MRI-Bx findings resulted in a greater percentage of pathologically positive cores (mean 37% vs 44%). Incorporation of multiparametric MRI and MRI-Bx results increased the recommended use and duration of ADT (duration increased in 28 of 73 patients and ADT was added for 8 of 73 patients).
In patients referred for radiation treatment, MRI-Bx resulted in an increase in the percentage of positive cores, Gleason score, and risk grouping. The benefit of treatment intensification in accordance with the MRI-Bx findings is unknown.
近期已将靶向磁共振成像（MRI）/超声融合前列腺活检（MRI-Bx）与标准的扩大六分区超声引导前列腺活检（SOC-Bx）进行了比较，结果显示前者能提高临床显著性前列腺癌的检出率。本研究旨在确定MRI-Bx对放射治疗和雄激素剥夺治疗（ADT）建议的影响。
纳入所有在本机构接受过放射治疗且已接受SOC-Bx和MRI-Bx的患者。根据临床T分期、治疗前前列腺特异性抗原和 Gleason评分，将患者分为美国国立综合癌症网络风险组，并给出放射治疗或ADT建议。评估多参数MRI、SOC-Bx和MRI-Bx后推荐治疗的强化情况。
2008年1月至2016年1月，73例患者在本机构同时接受SOC-Bx和MRI-Bx后接受了放射治疗（47例曾接受过SOC-Bx）。与之前的SOC-Bx相比，重复进行SOC-Bx和MRI-Bx导致分级频繁上调（Gleason评分7分，6.7%对44.6%；P<0.001；Gleason评分8 - 10分，2.1%对38%；P<0.001）。MRI-Bx使被归类为极高风险的患者比例从24.7%增加到41.1%（P = 0.027）。与单独的SOC-Bx相比，纳入MRI-Bx结果导致病理阳性核心的比例更高（平均37%对44%）。纳入多参数MRI和MRI-Bx结果增加了ADT的推荐使用和持续时间（73例患者中有28例持续时间增加，73例患者中有8例增加了ADT）。
在接受放射治疗的患者中，MRI-Bx导致阳性核心比例、Gleason评分和风险分组增加。根据MRI-Bx结果强化治疗的益处尚不清楚。
