低促性腺激素性性腺功能减退症与多参数 MRI 及 MRI-TRUS 融合活检在前列腺癌检测中的应用。
Hypogonadism and prostate cancer detection on multiparametric MRI and mpMRI-TRUS fusion biopsy.
机构信息
Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
出版信息
Int Urol Nephrol. 2020 Apr;52(4):633-638. doi: 10.1007/s11255-019-02354-4. Epub 2019 Dec 5.
PURPOSE
Currently, there is a dearth of data concerning the impact of hypogonadism on prostate cancer detection by imaging. In this study, we evaluated the performance of multiparametric MRI (mpMRI) and mpMRI-TRUS fusion biopsy in hypogonadal patients.
MATERIALS AND METHODS
Clinical and pathologic data from a prospectively maintained, single-institution database of patients who underwent 3T mpMRI and fusion biopsy between 2007 and 2016 were analyzed. Hypogonadism was defined by an institutional cutoff of serum testosterone ≤ 180 ng/dL; T2, DWI, and DCE scores were calculated from mpMRI. Cancer detection rates were compared by Chi-square tests. Multivariate logistic regression was undertaken to evaluate the impact of hypogonadism on clinically significant cancer detection by systematic and fusion biopsy.
RESULTS
We included 522 patients in our study who had total testosterone levels measured within 90 days of mpMRI. Of these, 49 (9.4%) were hypogonadal. Median total testosterone was 148 ng/dL (IQR 41) in the hypogonadal group, and 304 ng/dL (IQR 132) in the normogonadal group (p < 0.001). Imaging results were comparable between the hypo and normogonadal groups. In the hypogonadal group, systematic biopsy detected clinically significant cancer in 28.6% of patients compared to 40.8% with fusion biopsy. In the normogonadal cohort, systematic and fusion biopsy detected 37.3% and 43.2% CS cancer, respectively. In the hypogonadal cohort, fusion biopsy detected 12.2% more CS cancers compared to systematic biopsy, while it detected only 5.9% more in the normogonadal cohort. On multivariate analysis, hypogonadism was found to be an independent predictor of decreased CS cancer detection on systematic (p = 0.048), but not on fusion biopsy (p = 0.170).
CONCLUSIONS
Hypogonadism is an independent predictor of lower CS cancer detection on systematic biopsy. However, it fails to significantly impact CS detection on fusion biopsy with comparable cancer detection rates in both groups. Patients with hypogonadism may benefit more from fusion biopsy than normogonadal patients.
目的
目前，关于性腺功能减退症对影像学前列腺癌检测的影响的数据匮乏。本研究评估了多参数 MRI（mpMRI）和 mpMRI-TRUS 融合活检在性腺功能减退症患者中的表现。
材料与方法
对 2007 年至 2016 年间在我院接受 3T mpMRI 和融合活检的患者前瞻性维护的单中心数据库中的临床和病理数据进行了分析。性腺功能减退症的定义为血清睾酮≤180ng/dL 的医院截断值；mpMRI 计算 T2、DWI 和 DCE 评分。采用卡方检验比较癌症检出率。采用多变量逻辑回归评估性腺功能减退症对系统和融合活检中临床显著癌症检出的影响。
结果
本研究共纳入 522 例患者，他们在 mpMRI 检查后 90 天内测量了总睾酮水平。其中，49 例（9.4%）为性腺功能减退症。在性腺功能减退症组中，中位数总睾酮为 148ng/dL（IQR 41），在正常组中为 304ng/dL（IQR 132）（p<0.001）。在性腺功能减退症组和正常组中，影像学结果相似。在性腺功能减退症组中，系统活检检测到临床显著癌症的患者占 28.6%，而融合活检的患者占 40.8%。在正常组中，系统活检和融合活检分别检测到 37.3%和 43.2%的 CS 癌。在性腺功能减退症组中，融合活检比系统活检多检测到 12.2%的 CS 癌，而在正常组中仅多检测到 5.9%。多变量分析发现，性腺功能减退症是系统活检中 CS 癌检出率降低的独立预测因素（p=0.048），但不是融合活检的独立预测因素（p=0.170）。
结论
性腺功能减退症是系统活检中 CS 癌检出率降低的独立预测因素。然而，它并没有显著影响两组之间具有可比癌症检出率的融合活检中的 CS 检测。性腺功能减退症患者可能比正常组患者从融合活检中获益更多。
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