Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
Department of Medicine Statistics Core, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
J Urol. 2019 Jan;201(1):91-97. doi: 10.1016/j.juro.2018.08.043.
Three Tesla multiparametric magnetic resonance imaging with PI-RADS™ (Prostate Imaging Reporting and Data System) version 2 scoring is a common tool in prostate cancer diagnosis which informs the likelihood of a cancerous lesion. We investigated whether PI-RADS version 2 also predicts adverse pathology features mainly in patients with biopsy Gleason score 3 + 4 disease.
We reviewed the records of 326 consecutive men with a preoperative template and/or magnetic resonance imaging-ultrasound fusion biopsy Gleason score of 6-7 from a prospectively maintained database of men who underwent robotic radical prostatectomy. The primary analysis was done in patients with biopsy Gleason score 3 + 4 to assess the primary outcome of adverse pathology features on univariate and multivariate logistic regression. The secondary outcome was biochemical recurrence-free survival using the Kaplan-Meier method. Similar analysis was done in patients with a biopsy Gleason score of 6-7.
Of men with Gleason score 3 + 4 findings 27%, 15%, 36% and 23% showed a PI-RADS version 2 score of 0-2, 3, 4 and 5, respectively. On univariate analysis PI-RADS version 2 category 5 predicted adverse pathology features vs categories 0-2 (OR 10.7, 95% CI 3.7-31, p ≤0.001). On multivariate analysis the PI-RADS version 2 category 5 was associated with adverse pathology when adjusting for preoperative magnetic resonance imaging targeted biopsy (OR 11.4, 95% CI 3.7-35, p ≤0.0001). In men with a targeted biopsy Gleason score of 3 + 4 prostate cancer PI-RADS version 2 category 5 was associated with adverse pathology (OR 14.7, 95% CI 1.5-146.9, p = 0.02). Of men with biopsy Gleason score 3 + 4 disease 92% and 58% with a PI-RADS version 2 score of 4 and 5, respectively, had 2-year biochemical recurrence-free survival.
A PI-RADS version 2 category 5 lesion in patients with a biopsy Gleason score 3 + 4 lesion predicted adverse pathology features and biochemical recurrence-free survival. These findings suggest that preoperative 3 Tesla multiparametric magnetic resonance imaging may serve as a prognostic marker of treatment outcomes independently of biopsy Gleason score or biopsy type.
三特斯拉多参数磁共振成像与 PI-RADS™（前列腺影像报告和数据系统）第 2 版评分是前列腺癌诊断中的常用工具，可告知癌性病变的可能性。我们研究了 PI-RADS 第 2 版是否也可预测主要在活检 Gleason 评分 3+4 疾病患者中的不良病理特征。
我们回顾了 326 例连续男性患者的记录，这些患者来自前瞻性维护的数据库，数据库中包含接受机器人辅助根治性前列腺切除术的男性，他们在术前模板和/或磁共振成像-超声融合活检中具有 Gleason 评分 6-7。主要分析是在活检 Gleason 评分 3+4 的患者中进行的，以评估单变量和多变量逻辑回归分析中的不良病理特征的主要结局。次要结局是使用 Kaplan-Meier 方法评估生化无复发生存率。在活检 Gleason 评分 6-7 的患者中也进行了类似的分析。
在具有 Gleason 评分 3+4 发现的男性中，分别有 27%、15%、36%和 23%的患者 PI-RADS 第 2 版评分为 0-2、3、4 和 5。在单变量分析中，PI-RADS 第 2 版类别 5 预测与类别 0-2（OR 10.7，95%CI 3.7-31，p≤0.001）相比具有不良病理特征。在多变量分析中，当调整术前磁共振成像靶向活检时，PI-RADS 第 2 版类别 5 与不良病理相关（OR 11.4，95%CI 3.7-35，p≤0.0001）。在具有靶向活检 Gleason 评分 3+4 前列腺癌的男性中，PI-RADS 第 2 版类别 5 与不良病理相关（OR 14.7，95%CI 1.5-146.9，p=0.02）。在具有活检 Gleason 评分 3+4 疾病的男性中，分别有 92%和 58%的患者 PI-RADS 第 2 版评分 4 和 5 具有 2 年生化无复发生存率。
PI-RADS 第 2 版类别 5 病变在活检 Gleason 评分 3+4 病变患者中预测不良病理特征和生化无复发生存率。这些发现表明，术前 3 特斯拉多参数磁共振成像可作为独立于活检 Gleason 评分或活检类型的治疗结果的预后标志物。
