Urology Department, Rambam Health Center, Haifa Israel.
Urology Department, Bnai-Zion Medical Center, Haifa Israel.
Urol Oncol. 2021 Oct;39(10):728.e7-728.e11. doi: 10.1016/j.urolonc.2020.12.029. Epub 2021 Jan 13.
Diagnosis of prostate cancer (CaP) is based on digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) level. This approach lacks sensitivity and specificity and is associated with many negative biopsies, high rate of diagnosing clinically insignificant disease and lacks accuracy to predict clinically significant (CS) cancer. The addition of multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy reduces the detection of low-grade tumors while improving the detection of CS CaP. Most studies that evaluated mpMRI performance did not separate the DRE status of the examined patients. Therefore, the aim of our study is to investigate whether mpMRI provides similar advantages in detection of CaP according to the DRE findings.
This prospective study included patients with clinically suspected CaP that were referred to MRI-fusion biopsy from 2014 to 2019. All patients had mpMRI of the prostate with an index lesion of PIRADS ≥3. Analysis was done comparing systemic and targeted biopsy. Patients were divided into two groups according to the DRE findings (positive or negative DRE) and the primary outcomes were compared between the 2 study groups: detection rate of CaP and the detection rate of CS disease defined as Gleason score ≥ 7.
The final study cohort included 86 patients: 47 with negative DRE and 39 with positive DRE. Overall cancer detection rate was higher in patients with a positive DRE (70.3% vs 48.9%, P <0.05). In the region of interest a higher overall detection rate and of CS disease was found in those with abnormal DRE (51.3% vs. 40.4% and 48.6% vs. 34.0% respectively). The systematic biopsy analysis showed an overall lower detection rate in the negative DRE group (8.5% vs. 18.9 %). The targeted biopsies detected more cancer and significant tumors per core in patients with positive DRE (29.2% vs. 18.5% and 22.1% vs. 14.5% respectively).
Patients submitted to fusion biopsy and have a positive DRE are diagnosed more often with CaP, have higher grade disease and larger tumors. In patients suspicious for CaP and having a significant lesion on mpMRI one should combine targeted and systematic biopsy regardless of the DRE status.
前列腺癌（CaP）的诊断基于直肠指检（DRE）和/或前列腺特异性抗原（PSA）水平升高。这种方法缺乏敏感性和特异性，与许多阴性活检、高比例的诊断为临床意义不大的疾病以及缺乏预测临床显著（CS）癌症的准确性有关。在前列腺活检前增加多参数磁共振成像（mpMRI）可降低低级别肿瘤的检出率，同时提高 CS CaP 的检出率。大多数评估 mpMRI 性能的研究并未对接受检查的患者的 DRE 状况进行区分。因此，我们的研究目的是调查 mpMRI 是否根据 DRE 结果提供了类似的优势，以检测 CaP。
这项前瞻性研究纳入了 2014 年至 2019 年间因临床疑似 CaP 而转至 MRI 融合活检的患者。所有患者均接受了前列腺 mpMRI 检查，指数病变的 PIRADS≥3。分析比较了系统和靶向活检。根据 DRE 结果（DRE 阳性或阴性）将患者分为两组，比较两组的主要结局：CaP 的检出率和定义为 Gleason 评分≥7 的 CS 疾病的检出率。
最终研究队列纳入 86 例患者：47 例 DRE 阴性，39 例 DRE 阳性。DRE 阳性患者的总体癌症检出率更高（70.3%比 48.9%，P<0.05）。在感兴趣区域，DRE 异常患者的总体检出率和 CS 疾病检出率更高（51.3%比 40.4%和 48.6%比 34.0%）。系统活检分析显示，DRE 阴性组的总体检出率较低（8.5%比 18.9%）。在 DRE 阳性患者中，靶向活检检测到更多的癌症和更多的每根核心显著肿瘤（29.2%比 18.5%和 22.1%比 14.5%）。
接受融合活检且 DRE 阳性的患者更常被诊断为 CaP，且患有更高级别的疾病和更大的肿瘤。对于可疑 CaP 且 mpMRI 上有明显病变的患者，无论 DRE 状况如何，都应结合靶向和系统活检。
