Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Investig Clin Urol. 2020 Nov;61(6):573-581. doi: 10.4111/icu.20200159.
To evaluate the usefulness of multiparametric magnetic resonance imaging (mpMRI) to avoid misclassification of patients with clinically significant prostate cancer (PCa) into active surveillance (AS).
Patients with Gleason grade group (GG) 1 PCa on systematic biopsy who underwent mpMRI before radical prostatectomy (RP) were included. mpMRI and pathologic results were compared between the AS and NOT-AS candidates. Unfavorable disease was defined as the identification of T3-4 disease or GG upgrade in the RP specimen. We established an ideal cutoff Prostate Imaging Reporting and Data System (PI-RADS) score for predicting unfavorable disease, and analyzed the location of index lesions on mpMRI.
PI-RADS scores were not significantly different between AS candidates (n=64) and NOT-AS candidates (n=136; p=0.629). Among 64 AS candidates, GG upgrading and unfavorable disease were diagnosed after RP in 24 (37.5%) and 25 (39.1%) patients, respectively. The rate of unfavorable disease was greater for patients with a PI-RADS score of 5 (83.3%) than in those with a score ≤4 (34.5%; p=0.030). Moreover, most PI-RADS 5 lesions in AS candidates were located in the anterior half of the prostate, with GG upgrading on targeted biopsy in 75.0% of cases.
Among the patients with GG 1 PCa, PI-RADS scores did not differ significantly between AS and NOT-AS candidates. Nonetheless, AS candidates with PI-RADS 5 lesions were diagnosed with unfavorable disease in >80% of RP specimens. Significant cancer located in the anterior half of the prostate including the transitional zone can be missed by systematic biopsy.
评估多参数磁共振成像（mpMRI）在避免将临床显著前列腺癌（PCa）患者错误分类为主动监测（AS）中的作用。
纳入经系统活检诊断为 Gleason 分级组（GG）1 级 PCa 且在根治性前列腺切除术（RP）前行 mpMRI 的患者。比较 AS 和非 AS 候选者的 mpMRI 和病理结果。不利疾病定义为 RP 标本中 T3-4 疾病或 GG 升级的识别。我们建立了预测不利疾病的理想前列腺影像报告和数据系统（PI-RADS）评分截断值，并分析了 mpMRI 上的指数病变位置。
AS 候选者（n=64）和非 AS 候选者（n=136；p=0.629）的 PI-RADS 评分无显著差异。在 64 名 AS 候选者中，24 名（37.5%）和 25 名（39.1%）患者在 RP 后分别诊断为 GG 升级和不利疾病。PI-RADS 评分 5 分的患者不利疾病发生率高于评分≤4 分的患者（83.3% vs. 34.5%；p=0.030）。此外，AS 候选者中大多数 PI-RADS 5 病变位于前列腺前半部分，其中 75.0%的病例在靶向活检时出现 GG 升级。
在 GG 1 级 PCa 患者中，AS 和非 AS 候选者的 PI-RADS 评分无显著差异。然而，PI-RADS 5 分的 AS 候选者在>80%的 RP 标本中诊断为不利疾病。包括移行区在内的前列腺前半部分的显著癌症可能会被系统活检遗漏。
