Departments of Clinical Medical Sciences (M.A.G., D.N.) and Paraclinical Sciences (S.M.), Faculty of Medical Sciences, Eric Williams Medical Sciences Complex, Building 39, First Floor Uriah Butler Highway, Champ Fleurs, University of the West Indies, St Augustine Campus, St Augustine, Trinidad; and Departments of Urology (A.P.R., K.S.) and Radiology (C.M.G., M.D.M., R.B.), San Fernando General Hospital, Paradise Pasture Independence Avenue, San Fernando, Trinidad.
Radiol Imaging Cancer. 2020 Jul 31;2(4):e200007. doi: 10.1148/rycan.2020200007. eCollection 2020 Jul.
To assess risk-group migration and subsequent management change following biparametric MRI using a risk-stratified approach in a group of Caribbean men with prostate adenocarcinoma being offered external beam radiation therapy (EBRT).
This retrospective study assessed the biparametric MRI findings in men who opted for EBRT from January 2018 to June 2019 ( = 79; mean age, 67.9 years ± 6.2 [standard deviation]). Serum prostate-specific antigen level, digital rectal examination findings, histologic grade group (GG) from transrectal US-guided biopsy, prior androgen deprivation therapy (ADT), and any prior CT results were used to stratify patients into low-, intermediate-, and high-risk groups, according to the National Comprehensive Cancer Network risk categories. Risk-group stratification prior to MRI separated patients into low- (seven of 79 [8.9%]), intermediate- (36 of 79 [45.6%]) and high-risk (36 of 79 [45.6%]) groups. Following MRI, any risk group (low, intermediate, high, nodal involvement, and metastatic disease) or oncologic management changes were recorded. Multivariable binary logistic regression analyses were used to assess predictor of upgrade status, with adjustment for demographic covariates jointly.
Following MRI, 30 of 79 (38.0%) patients had risk-group upshifts compared with their original assessment. Patients were recategorized into low risk (one of 79, 1.3%), intermediate risk (19 of 79, 24.1%), high risk (51 of 79, 64.6%), nodal involvement (one of 79, 1.3%), and metastatic disease (seven of 79, 8.9%). From the original groupings, there were six of seven (85.7%) from the low group, 18 of 36 (50.0%) from the intermediate group, and six of 36 (16.7%) from the high group that had risk group upward shifts. There was no association with GG: GG2 versus GG1, = .53; GG3 versus GG1, = .98; or prior ADT ( = .37) and the adjusted odds of risk-group upshifts. MRI findings resulted in treatment plan modification for 39 of 79 (49.4%) men overall.
Prostate MRI should be considered for patients in high-risk populations prior to EBRT because upstaging from MR image assessment may have implications for modification of treatment. MR-Imaging, Prostate, Radiation Therapy© RSNA, 2020See the commentary by Davenport and Shankar in this issue.
在一组选择外束放射治疗（EBRT）的加勒比男性前列腺腺癌患者中，使用风险分层方法评估基于双参数 MRI 的风险组迁移和随后的管理变化。
本回顾性研究评估了 2018 年 1 月至 2019 年 6 月间选择 EBRT 的 79 名男性的双参数 MRI 结果（平均年龄 67.9 岁±6.2[标准差]）。血清前列腺特异性抗原水平、直肠指诊、经直肠超声引导活检的组织学分级组（GG）、先前雄激素剥夺治疗（ADT）和任何先前的 CT 结果用于根据国家综合癌症网络风险类别将患者分层为低危、中危和高危组。MRI 前的风险组分层将患者分为低危组（79 例中的 7 例[8.9%]）、中危组（79 例中的 36 例[45.6%]）和高危组（79 例中的 36 例[45.6%]）。记录 MRI 后任何风险组（低危、中危、高危、淋巴结受累和转移性疾病）或肿瘤管理变化。使用多变量二项逻辑回归分析评估升级状态的预测因素，并共同调整人口统计学协变量。
与原始评估相比，79 例患者中有 30 例（38.0%）的风险组发生了变化。患者被重新分类为低危（79 例中的 1 例，1.3%）、中危（79 例中的 19 例，24.1%）、高危（79 例中的 51 例，64.6%）、淋巴结受累（79 例中的 1 例，1.3%）和转移性疾病（79 例中的 7 例，8.9%）。在原始分组中，低危组中有 6 例（85.7%）、中危组中有 18 例（50.0%）和高危组中有 6 例（16.7%）发生了风险组上移。GG 无相关性：GG2 与 GG1， =.53；GG3 与 GG1， =.98；或先前 ADT（ =.37）与风险组上移的调整后比值比无关。总体而言，79 例男性中有 39 例（49.4%）因 MRI 结果改变了治疗计划。
对于选择 EBRT 的高危人群，应考虑进行前列腺 MRI，因为 MRI 评估的升级可能会影响治疗方式的改变。MR-Imaging, Prostate, Radiation Therapy© RSNA, 2020。在本期中查看 Davenport 和 Shankar 的评论。
