Department of Urology, CHU Lille, Lille, France.
Division of Surgery and Interventional Science, University College London, London, United Kingdom.
J Urol. 2020 Jul;204(1):24-32. doi: 10.1097/JU.0000000000000757. Epub 2020 Jan 22.
We systematically reviewed the literature on predictive factors for clinically significant prostate cancer diagnosis after prebiopsy negative magnetic resonance imaging in prostate cancer naïve patients.
The MEDLINE® and Scopus® databases were searched up to March 2019. The review protocol was published in the PROSPERO database (CRD42019125549). The clinical factors and markers studied were age, prostate specific antigen, prostate specific antigen isoforms, prostate specific antigen density, PCA3, prostate volume, family history, ethnicity and risk calculators. The primary objective was to determine their predictive ability for clinically significant prostate cancer diagnosis. Secondary objectives included meta-analysis of the negative predictive value of prebiopsy negative magnetic resonance imaging when combined with these predictive factors.
A total of 16 studies were eligible for inclusion. Few studies reported negative predictive value of magnetic resonance imaging combined with a marker. Prostate specific antigen density was the best studied and the strongest predictor of clinically significant prostate cancer in men with prebiopsy negative magnetic resonance imaging. There were 8 studies (1,015 patients) eligible for meta-analysis of the added value of prostate specific antigen density less than 0.15 ng/ml/ml to magnetic resonance imaging in reducing the risk of missing clinically significant prostate cancer. When combined with prostate specific antigen density, overall magnetic resonance imaging negative predictive value increased from 84.4% to 90.4% in cancer naïve patients. The increase was from 82.7% to 88.7% in biopsy naïve and from 88.2% to 94.1% in previous negative biopsy subgroups.
The use of prostate specific antigen density less than 0.15 ng/ml/ml in the presence of prebiopsy negative magnetic resonance imaging was the most useful factor to identify men without clinically significant prostate cancer who could avoid biopsy.
我们系统地回顾了前列腺癌初诊患者行 MRI 引导下前列腺穿刺活检前 MRI 阴性后预测临床显著前列腺癌诊断的相关文献。
检索 MEDLINE® 和 Scopus® 数据库，检索时间截至 2019 年 3 月。该综述方案已在 PROSPERO 数据库（CRD42019125549）中注册。研究中纳入的临床因素和标志物包括年龄、前列腺特异抗原、前列腺特异抗原同工型、前列腺特异抗原密度、PCA3、前列腺体积、家族史、种族和风险计算器。主要目的是确定这些因素对临床显著前列腺癌诊断的预测能力。次要目的包括分析 MRI 阴性结合这些预测因素时的阴性预测值的荟萃分析。
共有 16 项研究符合纳入标准。很少有研究报道 MRI 联合标志物的阴性预测值。前列腺特异抗原密度是研究最多、对初诊 MRI 阴性的男性临床显著前列腺癌预测最强的因素。有 8 项研究（1015 例患者）符合纳入标准，可对前列腺特异抗原密度低于 0.15ng/ml/ml 联合 MRI 减少漏诊临床显著前列腺癌风险的附加价值进行荟萃分析。当与前列腺特异抗原密度联合使用时，MRI 阴性预测值在癌症初诊患者中从 84.4%增加到 90.4%，在活检初诊患者中从 82.7%增加到 88.7%，在之前阴性活检患者中从 88.2%增加到 94.1%。
在 MRI 引导下前列腺穿刺活检前 MRI 阴性时，使用前列腺特异抗原密度低于 0.15ng/ml/ml 是识别无临床显著前列腺癌且可避免活检的男性的最有用因素。
