Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Eur Urol. 2021 Nov;80(5):549-563. doi: 10.1016/j.eururo.2021.05.001. Epub 2021 May 19.
Although magnetic resonance imaging (MRI) is broadly implemented into active surveillance (AS) protocols, data on the reliability of serial MRI in order to help guide follow-up biopsy are inconclusive.
To assess the diagnostic estimates of serial prostate MRI for prostate cancer (PCa) progression during AS.
We systematically searched PubMed, Scopus, and Web of Science databases to select studies analyzing the association between changes on serial prostate MRI and PCa progression during AS. We included studies that provided data for MRI progression, which allowed us to calculate diagnostic estimates. We compared Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) accuracy with institution-specific definitions.
We included 15 studies with 2240 patients. Six used PRECISE criteria and nine institution-specific definitions of MRI progression. The pooled PCa progression rate, which included histological progression to Gleason grade ≥2, was 27%. The pooled sensitivity and specificity were 0.59 (95% confidence interval [CI] 0.44-0.73) and 0.75 (95% CI 0.66-0.84) respectively. There was significant heterogeneity between included studies. Depending on PCa progression prevalence, the pooled negative predictive value for serial prostate MRI ranged from 0.81 (95% CI 0.73-0.88) to 0.88 (95% CI 0.83-0.93) and the pooled positive predictive value ranged from 0.37 (95% CI 0.24-0.54) to 0.50 (95% CI 0.36-0.66). There were no significant differences in the pooled sensitivity (p = 0.37) and specificity (p = 0.74) of PRECISE and institution-specific schemes.
Serial MRI still should not be considered a sole factor for excluding PCa progression during AS, and changes on MRI are not accurate enough to indicate PCa progression. There was a nonsignificant trend toward improved diagnostic estimates of PRECISE recommendations. These findings highlight the need to further define the optimal triggers and timing of biopsy during AS, as well as the need for optimizing the quality, interpretation, and reporting of serial prostate MRI.
Our study suggests that serial prostate magnetic resonance imaging (MRI) alone in patients on active surveillance is not accurate enough to reliably rule out or rule in prostate cancer progression. Other clinical factors and biomarkers along with serial MRI are required to safely tailor the intensity of follow-up biopsies.
尽管磁共振成像（MRI）广泛应用于主动监测（AS）方案中，但有关用于指导后续活检的连续 MRI 可靠性的数据尚无定论。
评估连续前列腺 MRI 对 AS 期间前列腺癌（PCa）进展的诊断评估。
我们系统地检索了 PubMed、Scopus 和 Web of Science 数据库，以选择分析连续前列腺 MRI 变化与 AS 期间 PCa 进展之间关联的研究。我们纳入了提供 MRI 进展数据的研究，这使我们能够计算诊断评估。我们将前列腺癌放射学变化估计连续评估（PRECISE）的准确性与机构特定定义进行了比较。
我们纳入了 15 项研究，共 2240 例患者。其中 6 项研究使用了 PRECISE 标准，9 项研究使用了机构特定的 MRI 进展定义。包括组织学进展为 Gleason 分级≥2 在内的 PCa 进展总发生率为 27%。汇总的敏感性和特异性分别为 0.59（95%置信区间 [CI] 0.44-0.73）和 0.75（95% CI 0.66-0.84）。纳入的研究之间存在显著异质性。根据 PCa 进展的流行率，连续前列腺 MRI 的汇总阴性预测值范围为 0.81（95% CI 0.73-0.88）至 0.88（95% CI 0.83-0.93），汇总阳性预测值范围为 0.37（95% CI 0.24-0.54）至 0.50（95% CI 0.36-0.66）。PRECISE 和机构特定方案的汇总敏感性（p=0.37）和特异性（p=0.74）无显著差异。
连续 MRI 仍不应被视为在 AS 期间排除 PCa 进展的唯一因素，并且 MRI 上的变化不足以准确指示 PCa 进展。PRECISE 建议的诊断评估有改善的趋势，但不显著。这些发现强调了需要进一步定义 AS 期间活检的最佳触发因素和时机，以及需要优化连续前列腺 MRI 的质量、解释和报告。
我们的研究表明，在主动监测的患者中，单独进行前列腺磁共振成像（MRI）检查不足以可靠地排除或确定前列腺癌进展。需要其他临床因素和生物标志物以及连续 MRI 来安全地调整随访活检的强度。
