Zhu Guangbin, Wang Quan
Department of Radiology, the Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Department of the medical image, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China.
Medicine (Baltimore). 2018 Sep;97(36):e11962. doi: 10.1097/MD.0000000000011962.
Prostate-specific antigen is not useful for detection of prostate cancer in Chinese men. The major problems in prostate cancer patients are overdiagnosis and overtreatment. The objective of the study was to test the hypothesis that targeted biopsy is an accurate diagnostic tool for prostate cancer detection than standard biopsy in Chinese men.Total, 998 patients whom multiparticulate multiparametric magnetic resonance imaging had revealed at least 1 lesion in the prostate were included in a cohort. Patients were subjected to magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy followed US-guided biopsy. Benefits of a diagnostic test were evaluated by decision curve analysis. Patients who were diagnosed as having prostate cancer by either of biopsies were subjected to radical prostatectomies followed by whole-mounted pathology (n = 578). Spearman rank correlation was performed between the biopsy results and the subtype of prostate cancer at 99% of confidence level.With respect to whole-mounted pathology, for US-guided biopsy, MRI/US fusion-guided biopsy, and combined data of both biopsies, sensitivities were 0.973, 0.983, and 0.973 and accuracies were 0.837, 0.91, and 0.917, respectively. MRI/US fusion-guided biopsy (P = .165) and combined data of both biopsies (P = .182) had the same specificity to whole-mount pathology. However, a US-guided biopsy had not the same specificity to whole-mount pathology (P = .0003). Decision-making zones for radical prostatectomy of different biopsies were in the order of combined data of both biopsies >MRI/US fusion-guided biopsy >US-guided biopsy.Only the targeted biopsy is recommended for the diagnosis of prostate cancer.
前列腺特异性抗原对中国男性前列腺癌的检测并无用处。前列腺癌患者的主要问题是过度诊断和过度治疗。本研究的目的是检验以下假设：对于中国男性，靶向活检在前列腺癌检测方面是比标准活检更准确的诊断工具。共有998例患者纳入队列，这些患者的多参数磁共振成像显示前列腺至少有1个病灶。患者先接受磁共振成像（MRI）/超声（US）融合引导活检，然后接受超声引导活检。通过决策曲线分析评估诊断试验的益处。两种活检中任何一种被诊断为前列腺癌的患者均接受根治性前列腺切除术，随后进行全层病理检查（n = 578）。在99%置信水平下，对活检结果与前列腺癌亚型进行Spearman等级相关性分析。就全层病理而言，超声引导活检、MRI/US融合引导活检以及两种活检的联合数据的敏感性分别为0.973、0.983和0.973，准确性分别为0.837、0.91和0.917。MRI/US融合引导活检（P = 0.165）和两种活检的联合数据（P = 0.182）对全层病理的特异性相同。然而，超声引导活检对全层病理的特异性不同（P = 0.0003）。不同活检方式下根治性前列腺切除术的决策区间顺序为：两种活检的联合数据＞MRI/US融合引导活检＞超声引导活检。仅推荐靶向活检用于前列腺癌的诊断。
