Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center of China, Beijing, China.
Department of Radiology, Peking University First Hospital, Beijing, China.
Clin Genitourin Cancer. 2021 Aug;19(4):288-295. doi: 10.1016/j.clgc.2020.12.007. Epub 2021 Jan 7.
Multiparametric magnetic resonance imaging (mpMRI) has been shown to have a good performance in predicting cancer among patients with a prostate-specific antigen (PSA) level of 4 to 10 ng/mL. However, lesion location on mpMRI has never been separately considered.
Patients with PSA level of 4 to 10 ng/mL were prospectively enrolled and underwent transrectal ultrasound-guided prostate biopsy. Patient information was collected, and logistic regression analysis was performed to determine the predictive factors of clinically significant prostate cancer (csPCa). Patients were grouped by lesion location to determine the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 cutoff value in predicting csPCa.
Among 222 patients, 121 were diagnosed with PCa and 92 had csPCa. Age, prostate volume, PSA density, location (peripheral zone, csPCa only), and PI-RADS v2.1 score were correlated with PCa and csPCa, and PI-RADS v2.1 score was the best predictor. A PI-RADS v2.1 score of 4 was the best cutoff value for predicting csPCa in patients with lesions only in the transitional zone with respect to the Youden index (0.5896) and negative predictive value (93.10%) with acceptable sensitivity (81.82%) and specificity (77.14%). An adjustment of the cutoff value to 3 for lesions in the peripheral zone would increase the negative predictive value (92.00%) and decrease the false negative rate (2.90%) with an acceptable sensitivity (97.10%) and specificity (30.67%).
PI-RADS v2.1 score is an effective predictor of csPCa in patients with PSA levels of 4 to 10 ng/mL. Patients with transitional zone or peripheral zone lesions should undergo biopsy if the PI-RADS v2.1 score is ≥ 4 or ≥ 3, respectively.
多参数磁共振成像（mpMRI）已被证明在预测 PSA 水平为 4 至 10ng/ml 的患者的癌症方面具有良好的性能。然而，mpMRI 上的病变位置从未单独考虑过。
前瞻性纳入 PSA 水平为 4 至 10ng/ml 的患者，并进行经直肠超声引导下前列腺活检。收集患者信息，并进行逻辑回归分析，以确定预测临床显著前列腺癌（csPCa）的预测因素。根据病变位置将患者分组，以确定 PI-RADS v2.1 在预测 csPCa 中的截断值。
在 222 名患者中，121 名被诊断为 PCa，92 名患有 csPCa。年龄、前列腺体积、PSA 密度、位置（外周区，仅 csPCa）和 PI-RADS v2.1 评分与 PCa 和 csPCa 相关，PI-RADS v2.1 评分是最好的预测因素。PI-RADS v2.1 评分 4 是预测仅在外周区有病变的患者发生 csPCa 的最佳截断值，根据 Youden 指数（0.5896）和阴性预测值（93.10%），具有可接受的敏感性（81.82%）和特异性（77.14%）。对于外周区病变，将截断值调整为 3，可提高阴性预测值（92.00%），降低假阴性率（2.90%），同时保持可接受的敏感性（97.10%）和特异性（30.67%）。
PI-RADS v2.1 评分是 PSA 水平为 4 至 10ng/ml 的患者预测 csPCa 的有效指标。如果 PI-RADS v2.1 评分分别为≥4 或≥3，外周区或过渡区病变患者应进行活检。
