1 Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L340, Portland, OR 97239.
2 Department of Urology, Oregon Health & Science University, Portland, OR.
AJR Am J Roentgenol. 2019 Aug;213(2):371-376. doi: 10.2214/AJR.18.21009. Epub 2019 Apr 1.
The purpose of this study is to investigate the impact of direct MRI-guided biopsy of the prostate on clinical management in practice. We retrospectively identified 127 patients with unknown ( = 98) or untreated prostate cancer with a Gleason score of 6 ( = 29) who underwent direct MRI-guided biopsy of the prostate at our institution between August 2013 and January 2018, after initial multiparametric endorectal MRI examination revealed one or more Prostate Imaging Reporting and Data System (PI-RADS or PI-RADSv2) category 4 or 5 target lesion. All available medical and imaging records were reviewed to determine pertinent clinical details, biopsy findings, and postbiopsy management. The mean patient age was 68 years (interquartile range, 63-73 years). Findings from MRI-guided biopsy were positive for 93 of 127 patients (73%), with prostate cancer of Gleason score of 7 or higher diagnosed in 84 of these 93 patients (90%). When stratified by clinical scenario, the rate of positive biopsy findings was 66% (57/86) for patients who had negative findings from one or more prior transrectal ultrasound-guided biopsies, 83% (10/12) for biopsy-naive patients, and 90% (26/29) for patients undergoing active surveillance. Overall, 90 of 127 patients (71%) received a new ( = 67) or upgraded ( = 23) diagnosis of prostate cancer, and 57 of these 90 patients (63%) proceeded to receive treatment with prostatectomy, radiation, or androgen deprivation therapy. The results of this study suggest that direct MRI-guided biopsy is associated with high rates of significant prostate cancer detection and subsequent definitive treatment across common clinical scenarios and should be considered an important supplementary diagnostic tool in the appropriate setting.
本研究旨在探讨直接 MRI 引导下前列腺活检对临床实践中前列腺癌管理的影响。我们回顾性地确定了 127 名患者，这些患者在我们机构接受了直接 MRI 引导下的前列腺活检，他们患有未知（=98）或未经治疗的前列腺癌，Gleason 评分为 6（=29），并且在初始多参数直肠内 MRI 检查后发现一个或多个前列腺成像报告和数据系统（PI-RADS 或 PI-RADSv2）类别 4 或 5 目标病变。所有可用的医疗和影像学记录都进行了审查，以确定相关的临床细节、活检结果和活检后的管理。患者的平均年龄为 68 岁（四分位距，63-73 岁）。127 名患者中有 93 名（73%）的 MRI 引导活检结果为阳性，其中 84 名（90%）这些患者的前列腺癌 Gleason 评分为 7 或更高。按临床情况分层，1 次或多次经直肠超声引导活检阴性患者的阳性活检率为 66%（57/86），活检初筛患者为 83%（10/12），主动监测患者为 90%（26/29）。总的来说，127 名患者中有 90 名（71%）新诊断（=67）或升级诊断（=23）前列腺癌，其中 57 名（63%）患者接受了前列腺切除术、放疗或雄激素剥夺治疗。本研究结果表明，直接 MRI 引导下的前列腺活检与常见临床情况下高比例的显著前列腺癌检出率和随后的明确治疗相关，应被视为适当情况下重要的辅助诊断工具。
