mpMRI 在活检 ISUP 1 前列腺癌患者行根治性前列腺切除术的资格评定中的作用。
The role of mpMRI in qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy.
机构信息
Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Urology, Military Institute of Medicine, Warsaw, Poland.
出版信息
BMC Urol. 2021 May 18;21(1):82. doi: 10.1186/s12894-021-00850-3.
BACKGROUND
To investigate the role of mpMRI and high PIRADS score as independent triggers in the qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy.
METHODS
Between January 2017 and June 2019, 494 laparoscopic radical prostatectomies were performed in our institution, including 203 patients (41.1%) with ISUP 1 cT1c-2c PCa on biopsy. Data regarding biopsy results, digital rectal examination, PSA, mpMRI and postoperative pathological report have been retrospectively analysed.
RESULTS
In 183 cases (90.1%) mpMRI has been performed at least 6 weeks after biopsy. Final pathology revealed ISUP Gleason Grade Group upgrade in 62.6% of cases. PIRADS 5, PIRADS 4 and PIRADS 3 were associated with Gleason Grade Group upgrade in 70.5%, 62.8%, 48.3% of patients on final pathology, respectively. Within PIRADS 5 group, the number of upgraded cases was statistically significant.
CONCLUSIONS
PIRADS score correlates with an upgrade on final pathology and may justify shared decision of radical treatment in patients unwilling to repeated biopsies. However, the use of PIRADS 5 score as a sole indicator for prostatectomy may result in nonnegligible overtreatment rate.
背景
本研究旨在探讨 mpMRI 与高 PIRADS 评分作为独立触发因素在活检中 ISUP1 前列腺癌患者行根治性前列腺切除术的作用。
方法
2017 年 1 月至 2019 年 6 月，本中心共进行了 494 例腹腔镜根治性前列腺切除术，其中活检诊断为 ISUP1 cT1c-2c 前列腺癌的患者 203 例（41.1%）。回顾性分析了患者的活检结果、直肠指诊、PSA、mpMRI 和术后病理报告。
结果
183 例（90.1%）患者在活检后至少 6 周进行了 mpMRI 检查。最终病理显示，ISUP 分级升级的患者占 62.6%。PIRADS5、PIRADS4 和 PIRADS3 与最终病理的 ISUP 分级升级分别相关，发生率为 70.5%、62.8%和 48.3%。在 PIRADS5 组中，升级病例数有统计学意义。
结论
PIRADS 评分与最终病理升级相关，对于不愿重复进行活检的患者，可能支持行根治性治疗的共同决策。然而，仅使用 PIRADS5 评分作为前列腺切除术的单一指标可能导致不可忽视的过度治疗率。
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