Porzycki Paweł, Ciszkowicz Ewa
Department of Urology, Municipal Hospital Rzeszow, Rzeszow, Poland.
Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, Rzeszow, Poland.
J Contemp Brachytherapy. 2019 Dec;11(6):541-546. doi: 10.5114/jcb.2019.90085. Epub 2019 Dec 1.
Multiparametric magnetic resonance imaging (mpMRI) is an evolving non-invasive imaging modality that increases the accurate localization of prostate cancer (PCa) at the time of MRI targeted biopsy, enhancing clinical risk assessment, and improving the ability to appropriately counsel patients regarding therapy.
A total of forty patients with prostate-specific antigen (PSA), mpMRI and Gleason score (based on MRI template-guided cognitive biopsy) results were analyzed in this study, with eight patients (20%) diagnosed with PCa. The mpMRI was performed to facilitate the decision to perform prostate biopsy. Spearman's coefficient analysis was used to evaluate the relationships between characteristics. Diagnostic performance was assessed measuring the area under the curve (AUC) of the receiver operating characteristic (ROC) analysis. Diagnostic accuracy, sensitivity, and specificity were determined using the best cut-off on each ROC.
Out of all the study group, 55% of patients were subjected to primary biopsy and 45% were directed to repeated TRUS-Bx with the suspicion of prostate cancer. Forty suspected lesions on MRI images were identified with 5% of PI-RADS 1, 17.5% of PI-RADS 2, 32.5% of PI-RADS 3, 27.5% of PI-RADS 4 (27.5%) and 17.5% of PI-RADS 5. The highest correlation was observed for mpMRI results and Gleason score with Spearman's coefficient equal to 0.41 (95% CI: 0.104-0.646). ROC analysis revealed that mpMRI discriminates between directing the patients for prostate biopsy or active surveillance with AUC = 0.771 (0.117, 95% CI: 0.542-1.001).
Introducing pre-biopsy mpMRI into our contemporary PCa diagnosis pathway increased the diagnostic yield of transrectal biopsy by increasing the prostate cancer detection. This enabled the introduction of clinically significant prostate cancer (csPCa) treatment. mpMRI application also allowed biopsy to be avoided among patients with no csPCa.
多参数磁共振成像（mpMRI）是一种不断发展的非侵入性成像方式，它能在MRI靶向活检时提高前列腺癌（PCa）的准确定位，增强临床风险评估，并提高为患者提供恰当治疗建议的能力。
本研究共分析了40例有前列腺特异性抗原（PSA）、mpMRI及Gleason评分（基于MRI模板引导的认知活检）结果的患者，其中8例（20%）被诊断为PCa。进行mpMRI以辅助决定是否进行前列腺活检。采用Spearman系数分析评估各特征之间的关系。通过测量受试者操作特征（ROC）分析的曲线下面积（AUC）来评估诊断性能。使用每个ROC上的最佳截断值确定诊断准确性、敏感性和特异性。
在所有研究组中，55%的患者接受了初次活检，45%因怀疑前列腺癌而接受了重复经直肠超声引导下活检（TRUS-Bx）。在MRI图像上识别出40个可疑病变，其中5%为PI-RADS 1，17.5%为PI-RADS 2，32.5%为PI-RADS 3，27.5%为PI-RADS 4，17.5%为PI-RADS 5。观察到mpMRI结果与Gleason评分之间的相关性最高，Spearman系数为0.41（95%CI：0.104 - 0.646）。ROC分析显示，mpMRI区分患者进行前列腺活检或主动监测的AUC = 0.771（0.117，95%CI：0.542 - 1.001）。
将活检前mpMRI引入我们当代的PCa诊断途径，通过增加前列腺癌的检测率提高了经直肠活检的诊断 yield。这使得能够引入具有临床意义的前列腺癌（csPCa）治疗。mpMRI的应用还避免了在无csPCa的患者中进行活检。
