Eineluoto Juho T, Järvinen Petrus, Kenttämies Anu, Kilpeläinen Tuomas P, Vasarainen Hanna, Sandeman Kevin, Erickson Andrew, Mirtti Tuomas, Rannikko Antti
Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
PLoS One. 2017 Dec 27;12(12):e0189272. doi: 10.1371/journal.pone.0189272. eCollection 2017.
This study was conducted to describe the changes in repeat multiparametric MRI (mpMRI) occurring in prostate cancer (PCa) patients during active surveillance (AS), and to study possible associations between mpMRI-related parameters in predicting prostate biopsy (Bx) Gleason score (GS) upgrading >3+3 and protocol-based treatment change (TC).
The study cohort consisted of 76 AS patients with GS 3+3 PCa and at least two consecutive mpMRIs of the prostate performed between 2006-2015. Patients were followed according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol and an additional mpMRI. The primary end points were GS upgrading (GU) (>3+3) in protocol-based Bxs and protocol-based TC.
Out of 76 patients, 53 (69%) had progression (PIRADS upgrade, size increase or new lesion[s]), while 18 (24%) had radiologically stable disease, and 5 (7%) had regression (PIRADS or size decrease, disappearance of lesion[s]) in repeat mpMRIs during AS. PIRADS scores of 4-5 in the initial mpMRI were associated with GU (p = 0.008) and protocol-based TC (p = 0.009). Tumour progression on repeat mpMRIs was associated with TC (p = 0.045) but not with GU (p = 1.00). PIRADS scores of 4-5 predict GU (sensitivity 0.80 [95% confidence interval (CI); 0.51-0.95, specificity 0.62 [95% CI; 0.52-0.77]) with PPV and NPV values of 0.34 (95% CI; 0.21-0.55) and 0.93 (95% CI; 0.80-0.98), respectively.
mpMRI is a useful tool not only to select but also to monitor PCa patients on AS.
本研究旨在描述前列腺癌（PCa）患者在主动监测（AS）期间重复多参数磁共振成像（mpMRI）的变化，并研究mpMRI相关参数在预测前列腺穿刺活检（Bx） Gleason评分（GS）升级>3+3和基于方案的治疗改变（TC）之间的可能关联。
研究队列包括76例GS为3+3的PCa患者，他们在2006年至2015年期间至少接受了两次连续的前列腺mpMRI检查。患者按照国际前列腺癌主动监测（PRIAS）方案及额外的mpMRI进行随访。主要终点是基于方案的Bx中的GS升级（GU）（>3+3）和基于方案的TC。
76例患者中，53例（69%）出现进展（前列腺影像报告和数据系统[PIRADS]升级、大小增加或出现新病灶），18例（24%）疾病放射学稳定，5例（7%）在AS期间重复mpMRI时出现消退（PIRADS或大小减小、病灶消失）。初始mpMRI的PIRADS评分为4-5与GU（p = 0.008）和基于方案的TC（p = 0.009）相关。重复mpMRI上的肿瘤进展与TC相关（p = 0.045），但与GU无关（p = 1.00）。PIRADS评分为4-5预测GU（敏感性0.80[95%置信区间（CI）；0.51-0.95]，特异性0.62[95%CI；0.52-0.77]），阳性预测值（PPV）和阴性预测值（NPV）分别为0.34（95%CI；0.21-0.55）和0.93（95%CI；0.80-0.98）。
mpMRI不仅是选择AS中PCa患者的有用工具，也是监测这些患者的有用工具。
