Hospital Aleman de Buenos Aires, Buenos Aires, Argentina.
Hospital Aleman de Buenos Aires, Buenos Aires, Argentina.
Urol Oncol. 2021 Jul;39(7):431.e9-431.e13. doi: 10.1016/j.urolonc.2020.11.010. Epub 2020 Nov 19.
Currently, a new subclassification of the Pi-RADS 3 lesions and subgroups is being used: 3a (indolent or low-risk lesions with volume <0.5 ml) and 3b (significant or high-risk lesions with volume ≥0.5 ml). The prostate-specific antigen density (PSAd) has been identified as a diagnostic tool that helps to predict clinically significant prostate cancer (csCaP). The aim of this study is to evaluate the association of the volume of the Pi-RADS 3 lesions and the PSAd in the diagnosis of csCaP.
We conducted a retrospective study that included prostate biopsies performed using a transperineal approach and guided by ultrasound between 2015 and 2020. csCaP was defined as Gleason score ≥3 + 4. The population was divided into groups according to the Pi-RADS 3 subclassification and the PSAd value. We calculated sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of 3b lesions for the detection of high-grade prostate cancer, alone and combined with PSAD groups.
In total, 99 patients with Pi-RADS 3 lesions were included. Forty-three patients were in group 3a and 56, in 3b. Mean PSA was 7.28 ± 2.6 ng/ml. Pi-RADS 3a lesion did not present csCaP but 17.8% of Pi-RADS 3b lesion did. In group 3b with PSAd > 0.15, 62.5% presented csCaP. In those Pi-RADS 3b with PSAd ≤ 0.15, all biopsies were insignificant prostate cancer (isCaP) and 40 biopsies could have been avoided. Considering 3b as positive for csCaP detection, sensitivity was 100%, specificity 48.3%, NPV 17.8%, and PPV 100%. When adding PSAd to group 3b, sensitivity was 100%, specificity was 86.9%, NPV was 62.5%, PPV was 100%. In total, only the subgroup 3b with PSAd > 0.15 presented csCaP and 83.8% biopsies could be avoided.
In this series, the association of the volume of PIRADS 3 lesion and the PSAd improves specificity and PPV contributing to improve the management of csCaP.
目前，正在使用一种新的 Pi-RADS 3 病变的亚分类和亚组：3a（体积<0.5ml 的惰性或低风险病变）和 3b（体积≥0.5ml 的显著或高风险病变）。前列腺特异性抗原密度（PSAd）已被确定为一种有助于预测临床显著前列腺癌（csCaP）的诊断工具。本研究旨在评估 Pi-RADS 3 病变体积与 PSAd 在诊断 csCaP 中的相关性。
我们进行了一项回顾性研究，纳入了 2015 年至 2020 年间经会阴前列腺穿刺活检的患者。csCaP 的定义为 Gleason 评分≥3+4。根据 Pi-RADS 3 亚分类和 PSAd 值将人群分为不同组。我们计算了 3b 病变单独和与 PSAD 组联合检测高级别前列腺癌的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。
共纳入 99 例 Pi-RADS 3 病变患者。43 例为 3a 组，56 例为 3b 组。平均 PSA 为 7.28±2.6ng/ml。Pi-RADS 3a 病变未发现 csCaP，但 17.8%的 Pi-RADS 3b 病变存在。在 PSAd>0.15 的 3b 组中，62.5%存在 csCaP。在 PSAd≤0.15 的 Pi-RADS 3b 患者中，所有活检均为非显著性前列腺癌（isCaP），可避免 40 例活检。考虑到 3b 病变作为 csCaP 检测的阳性，敏感性为 100%，特异性为 48.3%，NPV 为 17.8%，PPV 为 100%。当将 PSAd 添加到 3b 组时，敏感性为 100%，特异性为 86.9%，NPV 为 62.5%，PPV 为 100%。总的来说，只有 PSAd>0.15 的 3b 亚组存在 csCaP，可避免 83.8%的活检。
在本系列研究中，Pi-RADS 3 病变体积与 PSAd 的联合应用提高了特异性和 PPV，有助于改善 csCaP 的管理。
