Gaunay Geoffrey, Patel Vinay, Shah Paras, Moreira Daniel, Hall Simon J, Vira Manish A, Schwartz Michael, Kreshover Jessica, Ben-Levi Eran, Villani Robert, Rastinehad Ardeshir, Richstone Lee
Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA.
Department of Urology, University of Illinois Chicago, Chicago, IL, USA.
Asian J Urol. 2017 Jan;4(1):68-74. doi: 10.1016/j.ajur.2016.09.011. Epub 2016 Nov 22.
Contemporary prostate cancer (PCa) screening modalities such as prostate specific antigen (PSA) and digital rectal examination (DRE) are limited in their ability to predict the detection of clinically significant disease. Multi-parametric magnetic resonance imaging (mpMRI) of the prostate has been explored as a staging modality for PCa. Less is known regarding its utility as a primary screening modality. We examined our experience with mpMRI as both a screening and staging instrument.
mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography (TRUS) biopsy findings. Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant (Gleason score ≥7) disease. Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy. mpMRI studies were also cross-referenced with RP specimens. Statistical analyses determined predictive ability of extracapsular extension (ECE), seminal vesicle involvement (SVI), and pathologic evidence of clinically significant disease (Gleason score ≥7).
Four hundred biopsy naïve or prior negative biopsy patients had positive mpMRI studies. Overall sensitivity, specificity, positive and negative predictive values were 94%, 37%, 58%, and 87%, respectively and 95%, 31%, 42%, and 93%, respectively for overall cancer detection and Gleason score ≥7 disease. In patients with no prior biopsy history, mpMRI sensitivity, specificity, positive and negative predictive values were 94%, 36%, 65%, and 82%, for all cancers, and 95%, 30%, 50%, and 89% for Gleason score≥7 lesions, respectively. In those with prior negative biopsy sensitivity, specificity, positive and negative predictive values were 94%, 37%, 52%, and 90% for all cancers, and 96%, 32%, 36%, and 96% for Gleason score ≥7 lesions, respectively. Seventy-four patients underwent radical prostatectomy (RP) after mpMRI. Lesion size on mpMRI correlated with the presence of Gleason score ≥7 cancers ( = 0.005). mpMRI sensitivity, specificity, positive and negative predictive values were 84%, 39%, 81%, and 44% respectively, for Gleason ≥7 cancer. For ECE and SVI, sensitivity and specificity were 58% and 98% and 44% and 97%, respectively.
mpMRI is an accurate predictor of TRUS biopsy and RP outcomes. mpMRI has significant potential to change PCa management, particularly in the screening population, in whom a significant proportion may avoid TRUS biopsy. Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.
当代前列腺癌（PCa）筛查方式，如前列腺特异性抗原（PSA）检测和直肠指检（DRE），在预测临床显著疾病的检测能力方面存在局限性。前列腺多参数磁共振成像（mpMRI）已被探索作为PCa的分期方式。关于其作为主要筛查方式的效用了解较少。我们考察了我们使用mpMRI作为筛查和分期工具的经验。
将2012年至2014年期间对无PCa患者进行的mpMRI研究与经直肠超声（TRUS）活检结果进行交叉对照。进行统计分析以确定mpMRI结果与总体癌症诊断及临床显著（Gleason评分≥7）疾病之间的关联。然后对有既往活检阴性病史的患者和无TRUS活检病史的患者进行亚组分析。mpMRI研究也与根治性前列腺切除术（RP）标本进行交叉对照。统计分析确定了包膜外侵犯（ECE）、精囊受累（SVI）以及临床显著疾病（Gleason评分≥7）的病理证据的预测能力。
400例未经活检或既往活检阴性的患者mpMRI检查结果为阳性。总体癌症检测的敏感性、特异性、阳性预测值和阴性预测值分别为94%、37%、58%和87%，Gleason评分≥7疾病的相应值分别为95%、31%、42%和93%。在无既往活检病史的患者中，mpMRI对所有癌症的敏感性、特异性、阳性预测值和阴性预测值分别为94%、36%、65%和82%，对Gleason评分≥7病变的相应值分别为95%、30%、50%和89%。在既往活检阴性的患者中，mpMRI对所有癌症的敏感性、特异性、阳性预测值和阴性预测值分别为94%、37%、52%和90%，对Gleason评分≥7病变的相应值分别为96%、32%（此处原文可能有误，推测应为32%）、36%和96%。74例患者在mpMRI检查后接受了根治性前列腺切除术（RP）。mpMRI上的病变大小与Gleason评分≥7癌症的存在相关（P = 0.005）。对于Gleason≥7癌症，mpMRI的敏感性、特异性、阳性预测值和阴性预测值分别为84%、39%、81%和44%。对于ECE和SVI，敏感性和特异性分别为58%和98%以及44%和97%。
mpMRI是TRUS活检和RP结果的准确预测指标。mpMRI有显著潜力改变PCa的管理方式，尤其是在筛查人群中，其中很大一部分人可能避免TRUS活检。有必要进行进一步研究以确定应如何将mpMRI纳入当前的PCa筛查和分期模式。
