Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Eur Urol. 2020 Oct;78(4):515-517. doi: 10.1016/j.eururo.2020.06.030. Epub 2020 Jul 4.
Multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer. It remains unclear, however, whether mpMRI can safely replace confirmatory or surveillance biopsies in men with low-risk disease managed with active surveillance (AS). Overall, 166 men were upgraded at a median of 29 mo (interquartile range 13-54). The overall negative predictive value (NPV) of mpMRI was 79.5% and ranged from 74.4% to 84.6% for all AS biopsies up to the fourth surveillance biopsy. In men with prostate-specific antigen density ≥0.15 ng/ml/cm, the overall NPV of mpMRI was 65.5% and ranged from 57.1% to 73.3% across serial mpMRI scans. These findings support the hypothesis that mpMRI is helpful but insufficient to rule out pathological reclassification, especially at confirmatory biopsy or in the presence of other risk factors. PATIENT SUMMARY: Multiparametric magnetic resonance imaging (mpMRI) alone misses a considerable percentage of clinically significant prostate cancers (Gleason grade group ≥2) in men on active surveillance for low-risk prostate cancer. We conclude that mpMRI alone cannot safely replace surveillance prostate biopsies, particularly at confirmatory biopsy or in the presence of other risk factors.
多参数磁共振成像（mpMRI）提高了临床上显著前列腺癌的检出率。然而，对于接受主动监测（AS）治疗的低危疾病患者，mpMRI 是否可以安全替代确认性或监测性活检，目前仍不清楚。总的来说，在中位时间 29 个月（四分位间距 13-54）时，有 166 名男性升级。mpMRI 的总体阴性预测值（NPV）为 79.5%，所有 AS 活检中，从第四次监测活检开始，NPV 范围为 74.4%至 84.6%。在前列腺特异性抗原密度≥0.15ng/ml/cm 的男性中，mpMRI 的总体 NPV 为 65.5%，在连续的 mpMRI 扫描中，NPV 范围为 57.1%至 73.3%。这些发现支持这样一种假设，即 mpMRI 是有帮助的，但不足以排除病理重新分类，尤其是在确认性活检或存在其他危险因素时。患者总结：对于接受低危前列腺癌主动监测的男性，多参数磁共振成像（mpMRI）单独检查会遗漏相当一部分临床上显著的前列腺癌（Gleason 分级组≥2）。我们得出结论，mpMRI 单独不能安全替代监测性前列腺活检，尤其是在确认性活检或存在其他危险因素时。
