Department of Radiology, Michigan Medicine, Ann Arbor, Michigan; Michigan Radiology Quality Collaborative, Michigan Medicine, Ann Arbor, Michigan.
Department of Radiology, Michigan Medicine, Ann Arbor, Michigan.
J Am Coll Radiol. 2019 Oct;16(10):1385-1392. doi: 10.1016/j.jacr.2018.11.031. Epub 2019 Feb 4.
To assess the temporary health impact of prostate multiparametric MRI (mpMRI) and transrectal prostate biopsy in an active surveillance prostate cancer population.
A two-arm institutional review board-approved HIPAA-compliant prospective observational patient-reported outcomes study was performed from November 2017 to July 2018. Inclusion criteria were men with Gleason 6 prostate cancer in active surveillance undergoing either prostate mpMRI or transrectal prostate biopsy. A survey instrument was constructed using validated metrics in consultation with the local patient- and family-centered care organization. Study subjects were recruited at the time of diagnostic testing and completed the instrument by phone 24 to 72 hours after testing. The primary outcome measure was summary testing-related quality of life (summary utility score), derived from the testing morbidities index (TMI) (scale: 0 = death and 1 = perfect health). TMI is stratified into seven domains, with each domain scored from 1 (no health impact) to 5 (extreme health impact). Testing-related quality-of-life measures in the two cohorts were compared with Mann-Whitney U test.
In all, 122 subjects were recruited, and 90% (110 of 122 [MRI 55 of 60, biopsy 55 of 62]) successfully completed the survey instrument. The temporary quality-of-life impact of transrectal biopsy was significantly greater than that of prostate mpMRI (0.82, 95% confidence interval [CI] 0.79-0.85, versus 0.95, 95% CI 0.94-0.97; P < .001). The largest mean domain-level difference was for intraprocedural pain (transrectal biopsy 2.6, 95% CI 2.4-2.8, versus mpMRI 1.3, 95% CI 1.1-1.5; P < .001).
Transrectal prostate biopsy has greater temporary health impact (lower testing-related quality-of-life measure) than prostate mpMRI.
评估前列腺多参数 MRI（mpMRI）和经直肠前列腺活检在主动监测前列腺癌人群中的临时健康影响。
这是一项于 2017 年 11 月至 2018 年 7 月进行的、具有机构审查委员会批准的、符合 HIPAA 规定的前瞻性观察性患者报告结局研究。纳入标准为接受前列腺 mpMRI 或经直肠前列腺活检的处于主动监测的 Gleason 6 前列腺癌男性。使用经过验证的指标，结合当地以患者和家庭为中心的护理组织，构建了一份调查工具。研究对象在诊断性检查时被招募，并在检查后 24 至 72 小时通过电话完成工具。主要结局测量指标是总结性检查相关生活质量（总结效用评分），源自检查发病率指数（TMI）（评分范围：0=死亡，1=完美健康）。TMI 分为七个领域，每个领域的评分范围为 1（无健康影响）至 5（极度健康影响）。使用 Mann-Whitney U 检验比较了两个队列的检查相关生活质量测量指标。
共招募了 122 名受试者，其中 90%（110/122[MRI 组 55/60，活检组 55/62]）成功完成了调查工具。经直肠活检的临时生活质量影响明显大于前列腺 mpMRI（0.82，95%置信区间 [CI]0.79-0.85，与 0.95，95%CI0.94-0.97；P<.001）。最大的平均域级差异为术中疼痛（经直肠活检 2.6，95%CI2.4-2.8，与 mpMRI 1.3，95%CI1.1-1.5；P<.001）。
经直肠前列腺活检比前列腺 mpMRI 具有更大的临时健康影响（较低的检查相关生活质量指标）。
