Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building Suite 4954, Mailstop LKS 5046, Cleveland, OH, 44106, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Int Urol Nephrol. 2019 Aug;51(8):1343-1348. doi: 10.1007/s11255-019-02158-6. Epub 2019 May 2.
To evaluate the trend that despite recent advances in the screening, diagnosis, and management of prostate cancer (PCa), African-Americans (AAs) continue to have poorer outcomes compared to their Caucasian (CAU) counterparts. The reason for this may be rooted in biological differences in the cancer between the two groups; however, there may be some inherent disparities within the efficacy of the screening modalities. In this study, we aim to evaluate the negative predictive value (NPV) of multi-parametric MRI (mpMRI) between AA compared to CAUs.
All mpMRI between January 2014 and June 2017 were evaluated. The MRIs were read by dedicated genitourinary radiologists. Subsequently, the readings were correlated to final pathology after the patients underwent radical prostatectomy. The NPV and negative likelihood ratios (-LR) of mpMRI were evaluated in AAs versus CAUs based on four cutoffs (≥ Grade I, ≥ Grade II, ≥ Grade III and ≥ Grade IV).
The mpMRI was almost equally as effective between AAs and CAUs in excluding Grade III (NPV = 89 and 94, respectively), and Grade IV or above (NPV = 96 and 98, respectively) PCa; however, the NPV of mpMRI was significantly lower for Grade I (NPV = 32 and 52, respectively) and Grade II (NPV = 50 and 79, respectively) PCa.
Despite advances in the screening for PCa, there are disparities noted in the efficacy of screening tools between AAs and CAUs. For this reason, patients should be risk stratified and their screening results should be evaluated with consideration given to their baseline risk.
评估尽管近年来在前列腺癌（PCa）的筛查、诊断和治疗方面取得了进展，但与白种人（CAU）相比，非裔美国人（AA）的预后仍然较差的趋势。造成这种情况的原因可能源于两组人群之间癌症的生物学差异；然而，在筛查方式的疗效方面可能存在一些固有的差异。在这项研究中，我们旨在评估 AA 与 CAU 之间多参数 MRI（mpMRI）的阴性预测值（NPV）。
评估了 2014 年 1 月至 2017 年 6 月期间的所有 mpMRI。mpMRI 由专门的泌尿生殖系统放射科医生进行解读。随后，在患者接受根治性前列腺切除术后，将 MRI 阅读结果与最终病理结果进行相关性分析。根据四个截断值（≥I 级、≥II 级、≥III 级和≥IV 级），评估 AA 与 CAU 之间 mpMRI 的 NPV 和负似然比（-LR）。
mpMRI 在排除 III 级（NPV=89 和 94）和 IV 级或更高分级（NPV=96 和 98）PCa 方面，AA 和 CAU 之间的效果几乎相同；然而，mpMRI 对 I 级（NPV=32 和 52）和 II 级（NPV=50 和 79）PCa 的 NPV 明显较低。
尽管在 PCa 的筛查方面取得了进展，但在 AA 和 CAU 之间，筛查工具的效果存在差异。因此，应根据患者的基线风险对患者进行风险分层，并在评估其筛查结果时考虑这一点。
