根据多参数磁共振成像结果的前列腺特异性抗原密度行为。

Prostatic-specific antigen density behavior according to multiparametric magnetic resonance imaging result.

机构信息

Department of Urology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.

Department of Radiology, Vall d´Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.

出版信息

Urol Oncol. 2020 May;38(5):410-417. doi: 10.1016/j.urolonc.2019.12.013. Epub 2020 Feb 15.

DOI:10.1016/j.urolonc.2019.12.013

PMID:32067845

Abstract

OBJECTIVE

To analyze prostatic-specific antigen density (PSAD) according to the Prostate Imaging Reporting and Data System (PIRADSv.2) score, in order to determine how it should be used.

METHODS

This correlative series considered 952 men with prostatic-specific antigen >3 ng/ml and/or abnormal digital rectal examination who were subjected to prostatic biopsy (PB) between 2016 and 2017. Of these men, 768 had no previous 5-α-reductase inhibitor use or history of prostate cancer (CaP) and had previously undergone 3-T multiparametric magnetic resonance imaging (mpMRI). In this sample, 549 men were biopsy-naïve and 219 had at least 1 previous negative PB. A 12-core transrectal ultrasound-guided PB was performed in all participants, as well as at least 2-core targeted biopsies of every detected lesion with a PIRADSv.2 score ≥3. Significant CaP (sCaP) was defined as an International Society of Uropathologist grade >1 or tumor length >4 mm.

RESULTS

The overall CaP detection was 41.7%, with sCaP detected in 37.4%. sCaP was detected in 4.3% of PIRADSv.2 <3, 21.5% of PIRADSv.2 =3, 56.6% of PIRADSv.2 =4, and 78.5% of PIRADSv.2 =5, (P < 0.001). Insignificant CaP detection ranged from 6.5% to 1.5% respectively (P = 0.099). PSAD was an independent predictor of sCaP (odds ratios 1.971, 95% confidence interval [1.633, 2.378], P <0.001) and mpMRI (OR 3.179, 95%CI [2.593, 4.950], P < 0.001). Age (P = 0.013), family history of CaP (P = 0.021), and the type of PB (initial vs. repeated, P < 0.001) were also independent predictors of sCaP. PSAD was determined by PIRADSv.2 (P = 0.013) and the presence of sCaP (P < 0.001). PSAD increased with PIRADSv.2 score, even in men with CaP (P < 0.001) and slightly in men without CaP (P = 0.019). The area under the curve for mpMRI increased from 0.830 to 0.869 when PSAD was associated, (P < 0.001). The area under the curve of PSAD decreased from 0.727 in men with a PIRADSv.2 score <3 to 0.706 in those with a score of 5.

CONCLUSIONS

The efficacy of PSAD to detect sCaP decreases with PIRADSv.2. Predictors other than mpMRI and PSAD exist. Considering these conditions, independent predictors should be integrated in a nomogram and risk-calculator to personalize PB recommendation.

摘要

目的

根据前列腺影像报告和数据系统（PIRADSv.2）评分分析前列腺特异性抗原密度（PSAD），以确定其应该如何使用。

方法

本相关性研究纳入了 2016 年至 2017 年间前列腺特异性抗原（PSA）>3ng/ml 且/或直肠指检异常的 952 名男性患者，他们均接受了前列腺活检（PB）。其中 768 名男性患者此前未使用过 5-α 还原酶抑制剂或患有前列腺癌（CaP）病史，且此前曾接受过 3-T 多参数磁共振成像（mpMRI）检查。在该样本中，549 名男性为首次接受 PB，219 名男性之前至少有 1 次 PB 结果为阴性。所有参与者均接受了经直肠超声引导的 12 针 PB，以及对每个 PIRADSv.2 评分≥3 的可疑病变进行至少 2 针靶向活检。国际泌尿病理学家协会（ISUP）分级>1 或肿瘤长度>4mm 的 CaP 被定义为有意义 CaP（sCaP）。

结果

总的 CaP 检出率为 41.7%，其中 sCaP 检出率为 37.4%。PIRADSv.2<3 的患者中 sCaP 检出率为 4.3%，PIRADSv.2=3 的患者中为 21.5%，PIRADSv.2=4 的患者中为 56.6%，PIRADSv.2=5 的患者中为 78.5%（P<0.001）。分别有 6.5%至 1.5%的患者为无意义 CaP（P=0.099）。PSAD 是 sCaP 的独立预测因子（优势比 1.971，95%置信区间[1.633，2.378]，P<0.001）和 mpMRI（OR 3.179，95%CI[2.593，4.950]，P<0.001）。年龄（P=0.013）、CaP 家族史（P=0.021）和 PB 类型（首次与重复，P<0.001）也是 sCaP 的独立预测因子。PSAD 由 PIRADSv.2 决定（P=0.013）和 sCaP 的存在（P<0.001）。PSAD 随着 PIRADSv.2 评分的增加而增加，即使在 CaP 患者中也是如此（P<0.001），在无 CaP 患者中略有增加（P=0.019）。当 PSAD 与 mpMRI 相关联时，mpMRI 的曲线下面积从 0.830 增加到 0.869（P<0.001）。当 PIRADSv.2 评分<3 时，PSAD 的曲线下面积从 0.727 降至 0.706，而 PIRADSv.2 评分≥5 时则保持不变。