Department of Urology, Southern Alberta Institute of Urology, 7007 14 St SW, Calgary, AB, T2V 1P9, Canada.
Department of Radiology, Southern Alberta Institute of Urology, Calgary, AB, Canada.
World J Urol. 2018 Dec;36(12):2021-2025. doi: 10.1007/s00345-018-2341-4. Epub 2018 May 28.
While an elevated PSA significantly increases the risk of men harboring prostate cancer, many men with a persistently elevated PSA have negative prostate biopsies. More recently, multiparametric MRI (mpMRI) has had promising implications for the diagnosis of prostate cancer. We aim to investigate the diagnostic role of mpMRI in predicting the future diagnosis of prostate cancer in patients with an initial negative biopsy.
This study included all men with negative biopsies, elevated PSA and mpMRI. All patients had their age, PSA, and PSAd recorded. mpMRI lesions were classified using the PI-RADS 2 scoring system.
mpMRI imaging was performed in 336 men with an initial negative biopsy, of whom 108, 111, 76 and 41 men underwent single, two, three and four biopsies, respectively. Of the 228 men with more than one biopsy, 115 patients were diagnosed with prostate cancer on further biopsies. Older patients and men with higher PSA, PSAd and PIRADS score had a significant risk to progress to cancer but only higher PSAd and higher PI-RADS score were significantly associated with clinically significant cancers. For clinically significant cancer; sensitivity and specificity of PI-RADS scoring was 86 and 45%, respectively, and a NPV of 87.6%. When combined with PSAd, NPV was 93%.
Men with benign prostatic biopsy and both PSAd < 0.15 and low PI-RADS score may avoid second biopsy. PI-RADS scoring system has a high sensitivity to diagnose clinically significant prostate cancer and repeat biopsy should be recommended in men with benign biopsy and high score.
虽然 PSA 升高显著增加了男性患有前列腺癌的风险，但许多 PSA 持续升高的男性前列腺活检结果为阴性。最近，多参数 MRI（mpMRI）在前列腺癌的诊断中具有广阔的应用前景。我们旨在研究 mpMRI 在预测初次活检阴性的患者未来前列腺癌诊断中的诊断作用。
本研究纳入了所有初次活检阴性、PSA 升高和 mpMRI 检查的男性患者。所有患者均记录了年龄、PSA 和 PSAd。mpMRI 病变采用 PI-RADS 2 评分系统进行分类。
336 例初次活检阴性的男性患者进行了 mpMRI 成像，其中 108、111、76 和 41 例分别接受了一次、两次、三次和四次活检。在 228 例进行了多次活检的男性中，115 例在进一步活检中被诊断为前列腺癌。年龄较大的患者和 PSA、PSAd 和 PIRADS 评分较高的患者进展为癌症的风险显著增加，但只有较高的 PSAd 和较高的 PI-RADS 评分与临床显著癌症显著相关。对于临床显著的癌症；PI-RADS 评分的敏感性和特异性分别为 86%和 45%，NPV 为 87.6%。当与 PSAd 结合时，NPV 为 93%。
对于初次活检为良性前列腺且 PSAd<0.15 和 PI-RADS 评分较低的男性，可以避免再次进行活检。PI-RADS 评分系统对诊断临床显著前列腺癌具有较高的敏感性，对于初次活检为良性且评分较高的男性，应推荐进行重复活检。
