Lim Christopher S, Abreu-Gomez Jorge, Leblond Michel-Alexandre, Carrion Ivan, Vesprini Danny, Schieda Nicola, Klotz Laurence
Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2021 Apr;15(4):115-121. doi: 10.5489/cuaj.6781.
We aimed to determine if clinical and imaging features can stratify men at higher risk for clinically significant (CS, International Society of Urological Pathology [ISUP] grade group ≥2) prostate cancer (PCa) in equivocal Prostate Imaging and Data Reporting System (PI-RADS) category 3 lesions on magnetic resonance imaging (MRI).
Approved by the institutional review board, this retrospective study involved 184 men with 198 lesions who underwent 3T-MRI and MRI-directed transrectal ultrasound biopsy for PI-RADS 3 lesions. Men were evaluated including clinical stage, prostate-specific antigen density (PSAD), indication, and MRI lesion size. Diagnoses for all men and by indication (no cancer, any PCa, CSPCa) were compared using multivariate logistic regression, including stage, PSAD, and lesion size.
We found an overall PCa rate of 31.8% (63/198) and 10.1% (20/198) CSPCa (13 grade group 2, five group 3, and two group 4). Higher stage (p=0.001), PSAD (p=0.007), and lesion size (p=0.015) were associated with CSPCa, with no association between CSPCa and age, PSA, or prostate volume (p>0.05). PSAD modestly predicted CSPCa area under the curve (AUC) 0.66 (95% confidence interval [CI] 0.518-0.794) in all men and 0.64 (0.487-0.799) for those on active surveillance (AS). Model combining clinical stage, PSAD, and lesion size improved accuracy for all men and AS (AUC 0.82 [0.736-0.910], p<0.001 and 0.785 [0.666-0.904], p<0.001). In men with prior negative biopsy and persistent suspicion, PSAD (0.90 [0.767-1.000]) was not different from the model (p>0.05), with optimal cutpoint of ≥0.215 ng/mL/cc achieving sensitivity/specificity of 85.7/84.4%.
PI-RADSv2 category 3 lesions are often not CSPCa. PSAD predicted CSPCa in men with a prior negative biopsy; however, PSAD alone had limited value, and accuracy improved when using a model incorporating PSAD with clinical stage and MRI lesion size.
我们旨在确定临床和影像特征能否对磁共振成像（MRI）上前列腺影像报告和数据系统（PI-RADS）分类为3类的可疑病变中具有临床显著意义（CS，国际泌尿病理学会[ISUP]分级组≥2）的前列腺癌（PCa）的高危男性进行分层。
本回顾性研究经机构审查委员会批准，纳入了184名患有198个病变的男性，他们接受了3T-MRI检查以及针对PI-RADS 3类病变的MRI引导下经直肠超声活检。对男性进行了评估，包括临床分期、前列腺特异性抗原密度（PSAD）、指征和MRI病变大小。使用多因素逻辑回归比较了所有男性以及按指征（无癌症、任何PCa、CSPCa）分类的诊断情况，包括分期、PSAD和病变大小。
我们发现总体PCa发生率为31.8%（63/198），CSPCa发生率为10.1%（20/198）（13例为2级组，5例为3级组，2例为4级组）。更高的分期（p = 0.001）、PSAD（p = 0.007）和病变大小（p = 0.015）与CSPCa相关，CSPCa与年龄、PSA或前列腺体积之间无关联（p>0.05）。在所有男性中，PSAD对CSPCa的曲线下面积（AUC）为0.66（95%置信区间[CI] 0.518 - 0.794），对于接受主动监测（AS）的男性为0.64（0.487 - 0.799）。结合临床分期、PSAD和病变大小的模型提高了所有男性和接受AS男性的诊断准确性（AUC分别为0.82 [0.736 - 0.910]，p<0.001和0.785 [0.666 - 0.904]，p<0.001）。在既往活检阴性且仍有怀疑的男性中，PSAD（0.90 [0.767 - 1.000]）与模型无差异（p>0.05），最佳切点≥0.215 ng/mL/cc时，敏感性/特异性为85.7/84.4%。
PI-RADSv2分类为3类的病变通常并非CSPCa。PSAD可预测既往活检阴性男性中的CSPCa；然而，单独的PSAD价值有限，当使用包含PSAD、临床分期和MRI病变大小的模型时，准确性有所提高。
