UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK.
Prog Urol. 2020 Dec;30(16):986-999. doi: 10.1016/j.purol.2020.09.012. Epub 2020 Sep 29.
Many guidelines now recommend multiparametric MRI (mpMRI) prior to an initial or repeat prostate biopsy. However, clinical decision making for men with a non-suspicious mpMRI (Likert or PIRADS score 1-2) varies.
To review the most recent literature to answer three questions. (1) Should we consider systematic biopsy if mpMRI is not suspicious? (2) Are there additional predictive factors that can help decide which patient should have a biopsy? (3) Can the low visibility of some cancers be explained and what are the implications?
A narrative review was performed in Medline databases using two searches with the terms "MRI" and "prostate cancer" and ("diagnosis" or "biopsy") and ("non-suspicious" or "negative" or "invisible"); "prostate cancer MRI visible". References of the selected articles were screened for additional articles.
Studies published in the last 5 years in English language were assessed for eligibility and selected if data was available to answer one of the three study questions.
Considering clinically significant cancer as ISUP grade≥2, the negative predictive value (NPV) of mpMRI in various settings and populations ranges from 76% to 99%, depending on cancer prevalence and the type of confirmatory reference test used. NPV is higher among patients with prior negative biopsy (88-96%), and lower for active surveillance patients (85-90%). The PSA density (PSAd) with a threshold of PSAd<0.15ng/ml/ml was the most studied and relevant predictive factor used in combination with mpMRI to rule out clinically significant cancer. Finally, mpMRI-invisible tumours appear to differ from a histopathological and genetic point of view, conferring clinical advantage to invisibility.
Most published data come from expert centres and results may not be reproducible in all settings.
mpMRI has high diagnostic accuracy and in cases of negative mpMRI, PSA density can be used to determine which patient should have a biopsy. Growing knowledge of the mechanisms and genetics underlying MRI visibility will help develop more accurate risk calculators and biomarkers.
目前许多指南建议在初始或重复前列腺活检前进行多参数 MRI（mpMRI）检查。然而，对于 mpMRI 检查结果不提示（Likert 或 PIRADS 评分 1-2）的男性，临床决策存在差异。
回顾最新文献，回答三个问题。（1）如果 mpMRI 检查不提示，我们是否应考虑进行系统性活检？（2）是否有其他预测因素可以帮助决定哪些患者应进行活检？（3）某些癌症可见度较低的原因是什么，这有何影响？
在 Medline 数据库中进行了两次检索，使用了“MRI”和“前列腺癌”以及“诊断”或“活检”和“不提示”或“阴性”或“不可见”；“前列腺癌 MRI 可见性”的术语。筛选了所选文章的参考文献，以获取更多文章。
评估过去 5 年以英文发表的研究是否符合入选标准，并在有数据可回答三个研究问题之一的情况下选择研究。
根据国际泌尿病理学会（ISUP）分级≥2 的临床显著癌症，在不同环境和人群中，mpMRI 的阴性预测值（NPV）范围为 76%至 99%，取决于癌症患病率和使用的确认参考测试类型。对于先前活检结果阴性的患者（88-96%），NPV 更高，而对于主动监测患者（85-90%）则较低。前列腺特异性抗原密度（PSAd）是最常研究和相关的预测因素，与 mpMRI 联合使用可排除临床显著癌症，其阈值为 PSAd<0.15ng/ml/ml。最后，mpMRI 不可见肿瘤从组织病理学和遗传学角度来看似乎不同，为不可见性带来临床优势。
大多数已发表的数据来自专家中心，结果可能无法在所有环境中复制。
mpMRI 具有较高的诊断准确性，在 mpMRI 检查结果阴性的情况下，PSAd 可用于确定哪些患者应进行活检。对 MRI 可见性背后的机制和遗传学的认识不断加深，将有助于开发更准确的风险计算器和生物标志物。
