Department of Urology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
J Cancer Res Clin Oncol. 2018 May;144(5):987-995. doi: 10.1007/s00432-018-2616-6. Epub 2018 Mar 5.
PURPOSE: To explore the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) for predicting prostate biopsy results in patients with prostate specific antigen (PSA) levels of 4-10 ng/ml. METHODS: We retrospectively reviewed multi-parameter magnetic resonance images from 528 patients with PSA levels of 4-10 ng/ml who underwent transrectal ultrasound-guided prostate biopsies between May 2015 and May 2017. Among them, 137 were diagnosed with prostate cancer (PCa), and we further subdivided them according to pathological results into the significant PCa (S-PCa) and insignificant significant PCa (Ins-PCa) groups (121 cases were defined by surgical pathological specimen and 16 by biopsy). Age, PSA, percent free PSA, PSA density (PSAD), prostate volume (PV), and PI-RADS score were collected. Logistic regression analysis was performed to determine predictors of pathological results. Receiver operating characteristic curves were constructed to analyze the diagnostic value of PI-RADS v2 in PCa. RESULTS: Multivariate analysis indicated that age, PV, percent free PSA, and PI-RADS score were independent predictors of biopsy findings, while only PI-RADS score was an independent predictor of S-PCa (P < 0.05). The areas under the receiver operating characteristic curve for diagnosing PCa with respect to age, PV, percent free PSA, and PI-RADS score were 0.570, 0.430, 0.589 and 0.836, respectively. The area under the curve for diagnosing S-PCa with respect to PI-RADS score was 0.732. A PI-RADS score of 3 was the best cutoff for predicting PCa, and 4 was the best cutoff for predicting S-PCa. Thus, 92.8% of patients with PI-RADS scores of 1-2 would have avoided biopsy, but at the cost of missing 2.2% of the potential PCa cases. Similarly, 83.82% of patients with a PI-RADS score ≤ 3 would have avoided biopsy, but at the cost of missing 3.3% of the potential S-PCa cases. CONCLUSIONS: PI-RADS v2 could be used to reduce unnecessary prostate biopsies in patients with PSA levels of 4-10 ng/ml.
目的：探讨前列腺影像报告和数据系统第 2 版（PI-RADS v2）在预测 PSA 水平为 4-10ng/ml 的患者前列腺活检结果中的价值。
方法：我们回顾性分析了 2015 年 5 月至 2017 年 5 月期间接受经直肠超声引导前列腺活检的 528 例 PSA 水平为 4-10ng/ml 的患者的多参数磁共振成像。其中 137 例诊断为前列腺癌（PCa），我们根据病理结果将其进一步分为有意义的 PCa（S-PCa）和无意义的有意义的 PCa（Ins-PCa）组（121 例由手术病理标本定义，16 例由活检定义）。收集年龄、PSA、游离 PSA 百分比、PSA 密度（PSAD）、前列腺体积（PV）和 PI-RADS 评分。采用 logistic 回归分析确定病理结果的预测因素。绘制受试者工作特征曲线分析 PI-RADS v2 对 PCa 的诊断价值。
结果：多因素分析表明，年龄、PV、游离 PSA 百分比和 PI-RADS 评分是活检结果的独立预测因素，而只有 PI-RADS 评分是 S-PCa 的独立预测因素（P<0.05）。年龄、PV、游离 PSA 百分比和 PI-RADS 评分诊断 PCa 的受试者工作特征曲线下面积分别为 0.570、0.430、0.589 和 0.836。PI-RADS 评分诊断 S-PCa 的曲线下面积为 0.732。PI-RADS 评分 3 分为预测 PCa 的最佳截断值，PI-RADS 评分 4 分为预测 S-PCa 的最佳截断值。因此，92.8%的 PI-RADS 评分 1-2 分的患者可以避免活检，但代价是漏诊 2.2%的潜在 PCa 病例。同样，PI-RADS 评分≤3 分的 83.82%的患者可以避免活检，但代价是漏诊 3.3%的潜在 S-PCa 病例。
结论：PI-RADS v2 可用于减少 PSA 水平为 4-10ng/ml 的患者不必要的前列腺活检。
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