Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
University of Exeter Medical School, Exeter, UK.
BJU Int. 2019 Jan;123(1):82-90. doi: 10.1111/bju.14420. Epub 2018 Jul 26.
To determine the extent to which clinically significant prostate cancer (csPCa) can be detected in a routine National Health Service setting in men with no previous biopsy, when multiparametric magnetic resonance imaging (mpMRI) is introduced into the diagnostic pathway.
In all, 1 090 mpMRIs were performed between July 2013 and April 2016 in biopsy-naïve men with an abnormal prostate-specific antigen level and/or digital rectal examination. Data were collected from patient records at the Royal Devon and Exeter NHS Foundation Trust. mpMRI Prostate Imaging Reporting and Data System (PI-RADS) scores were compared to transperineal or transrectal ultrasonography (TRUS)-guided biopsy findings as the reference standard. csPCa was defined as Gleason score of ≥3+4. The diagnostic accuracy of mpMRI was also assessed.
The mpMRI was interpretable in 1 023 men and 792 underwent biopsy, of which 106 were transperineal. The median number of cores taken in transperineal and TRUS-guided biopsy were 10 and 6, respectively. The detection rate of csPCa was 37%; csPCa rose from 15% of PI-RADS 1 and 2 to 86% of PI-RADS 5. The sensitivity, negative predictive value, specificity, and positive predictive value were 82%, 85%, 59% and 54%, respectively. The study is limited by its retrospective nature and lack of reporting of follow-up for 'missed cancers'. Men with low mpMRI PI-RADS were also less likely to undergo biopsy. Whilst this selection bias may overestimate the detection rate of csPCa, this reflects the shared decisions patients and clinicians make in day-to-day practice outside of research centres.
In a routine clinical setting, the higher the mpMRI PI-RADS, the greater the detection rate of csPCa in biopsy-naïve men. A normal mpMRI does not exclude csPCa; however, mpMRI may have utility in informing shared-decision making on whether to proceed to biopsy and subsequent treatment.
在常规国民保健服务（NHS）环境中，当将多参数磁共振成像（mpMRI）引入诊断途径时，确定在没有先前活检的情况下，能够在多大程度上检测到临床上显著的前列腺癌（csPCa）。
共有 1 090 名 mpMRI 于 2013 年 7 月至 2016 年 4 月期间在前列腺特异性抗原水平异常和/或直肠指检异常的活检初治男性中进行。数据从皇家德文郡和埃克塞特国民保健信托基金会的患者记录中收集。mpMRI 前列腺成像报告和数据系统（PI-RADS）评分与经会阴或经直肠超声（TRUS）引导活检结果进行比较，作为参考标准。csPCa 定义为 Gleason 评分≥3+4。还评估了 mpMRI 的诊断准确性。
1 023 名男性的 mpMRI 可解读，其中 792 名男性接受了活检，其中 106 名经会阴。经会阴和 TRUS 引导活检的中位数活检芯数分别为 10 个和 6 个。csPCa 的检出率为 37%；csPCa 从 PI-RADS 1 和 2 的 15%上升到 PI-RADS 5 的 86%。敏感性、阴性预测值、特异性和阳性预测值分别为 82%、85%、59%和 54%。该研究受其回顾性性质和缺乏对“漏诊癌症”随访的报告的限制。mpMRI PI-RADS 较低的男性也不太可能接受活检。虽然这种选择偏倚可能高估了 csPCa 的检出率，但这反映了患者和临床医生在研究中心以外的日常实践中共同做出的决策。
在常规临床环境中，mpMRI PI-RADS 越高，活检初治男性中 csPCa 的检出率越高。正常的 mpMRI 并不能排除 csPCa；然而，mpMRI 可能有助于告知是否进行活检和随后治疗的共同决策。
