UCL Division of Surgery & Interventional Science, University College London, London, UK; The Alan Turing Institute, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
UCL Division of Surgery & Interventional Science, University College London, London, UK; Centre for Medical Imaging, University College London, London, UK.
Eur Urol. 2021 Jan;79(1):20-29. doi: 10.1016/j.eururo.2020.09.043. Epub 2020 Oct 10.
False positive multiparametric magnetic resonance imaging (mpMRI) phenotypes prompt unnecessary biopsies. The Prostate MRI Imaging Study (PROMIS) provides a unique opportunity to explore such phenotypes in biopsy-naïve men with raised prostate-specific antigen (PSA) and suspected cancer.
To compare mpMRI lesions in men with/without significant cancer on transperineal mapping biopsy (TPM).
DESIGN, SETTING, AND PARTICIPANTS: PROMIS participants (n=235) underwent mpMRI followed by a combined biopsy procedure at University College London Hospital, including 5-mm TPM as the reference standard. Patients were divided into four mutually exclusive groups according to TPM findings: (1) no cancer, (2) insignificant cancer, (3) definition 2 significant cancer (Gleason ≥3+4 of any length and/or maximum cancer core length ≥4mm of any grade), and (4) definition 1 significant cancer (Gleason ≥4+3 of any length and/or maximum cancer core length ≥6mm of any grade).
Index and/or additional lesions present in 178 participants were compared between TPM groups in terms of number, conspicuity, volume, location, and radiological characteristics.
Most lesions were located in the peripheral zone. More men with significant cancer had two or more lesions than those without significant disease (67% vs 37%; p< 0.001). In the former group, index lesions were larger (mean volume 0.68 vs 0.50 ml; p< 0.001, Wilcoxon test), more conspicuous (Likert 4-5: 79% vs 22%; p< 0.001), and diffusion restricted (mean apparent diffusion coefficient [ADC]: 0.73 vs 0.86; p< 0.001, Wilcoxon test). In men with Likert 3 index lesions, logPSA density and index lesion ADC were significant predictors of definition 1/2 disease in a logistic regression model (mean cross-validated area under the receiver-operator characteristic curve: 0.77 [95% confidence interval: 0.67-0.87]).
Significant cancer-associated MRI lesions in biopsy-naïve men have clinical-radiological differences, with lesions seen in prostates without significant disease. MRI-calculated PSA density and ADC could predict significant cancer in those with indeterminate MRI phenotypes.
Magnetic resonance imaging (MRI) lesions that mimic prostate cancer but are, in fact, benign prompt unnecessary biopsies in thousands of men with raised prostate-specific antigen. In this study we found that, on closer look, such false positive lesions have different features from cancerous ones. This means that doctors could potentially develop better tools to identify cancer on MRI and spare some patients from unnecessary biopsies.
假阳性多参数磁共振成像（mpMRI）表型会导致不必要的活检。前列腺 MRI 成像研究（PROMIS）为探索活检初筛前列腺特异性抗原（PSA）升高且疑似癌症的男性中的此类表型提供了独特的机会。
比较经会阴前列腺靶向穿刺活检（TPM）有/无显著癌的男性的 mpMRI 病灶。
设计、地点和参与者：PROMIS 参与者（n=235）接受了 mpMRI 检查，随后在伦敦大学学院医院进行了联合活检，包括 5mm TPM 作为参考标准。根据 TPM 结果，患者被分为四个互斥组：（1）无癌症，（2）非显著癌症，（3）定义 2 显著癌症（任何长度的 Gleason ≥3+4 和/或任何分级的最大癌核心长度≥4mm），和（4）定义 1 显著癌症（任何长度的 Gleason ≥4+3 和/或任何分级的最大癌核心长度≥6mm）。
在 178 名参与者中，比较 TPM 组之间的指数和/或额外病灶的数量、显著性、体积、位置和影像学特征。
大多数病灶位于外周带。与无显著疾病的患者相比，有显著癌症的患者有两个或更多病灶的比例更高（67% vs 37%；p<0.001）。在前一组中，指数病灶更大（平均体积 0.68 vs 0.50ml；p<0.001，Wilcoxon 检验），更显著（Likert 4-5：79% vs 22%；p<0.001），弥散受限（平均表观扩散系数 [ADC]：0.73 vs 0.86；p<0.001，Wilcoxon 检验）。在有 Likert 3 指数病灶的男性中，logPSA 密度和指数病灶 ADC 是 logistic 回归模型中定义 1/2 疾病的显著预测因子（平均交叉验证受试者工作特征曲线下面积：0.77[95%置信区间：0.67-0.87]）。
在活检初筛 PSA 升高且疑似癌症的男性中，与显著癌症相关的 MRI 病灶具有临床影像学差异，在无显著疾病的前列腺中可见。MRI 计算的 PSA 密度和 ADC 可以预测 MRI 表型不确定的患者中存在显著癌症。
磁共振成像（MRI）上与前列腺癌类似但实际上是良性的病灶会导致数千名 PSA 升高的男性进行不必要的活检。在这项研究中，我们发现，仔细观察后，这些假阳性病灶与癌性病灶具有不同的特征。这意味着医生可以开发出更好的工具来识别 MRI 上的癌症，从而使一些患者免受不必要的活检。
