Department of Urology, Loyola University Medical Center, Maywood, Illinois.
Department of Urology, Loyola University Medical Center, Maywood, Illinois.
Urology. 2022 May;163:132-137. doi: 10.1016/j.urology.2021.07.005. Epub 2021 Jul 21.
To determine whether the frequency of anterior prostate lesions (APL) on multiparametric magnetic resonance imaging (mpMRI) prior to biopsy differed between African American (AA) and non-AA men and evaluate implications of race and tumor location for prostate cancer (PCa) detection.
Patients from the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (January 2015-December 2020) without prior diagnosis of PCa were evaluated for APLs by race. Multivariable logistic regression models evaluated predictors of APLs and associations of APLs and race with detection of any PCa (grade group 1+) and clinically significant PCa (csPCa; grade group 2+). Additional stratified and propensity score matched analyses were conducted.
Of 1,239 men included, 190 (15.3%) were AA and 302 (24.4%) had at least one APL with no differences by race on multivariable analysis. While men with APLs were twice as likely to harbor PCa or csPCa, the unadjusted proportion of targeted biopsy-confirmed APL PCa (12.6% vs 12.0%) or csPCa (8.4% vs 8.9%) were similar for AA and non-AA men. AA men had higher risk of prostate cancer on targeted cores (OR 1.66 (95%CI 1.06 - 2.61), P = 0.026) which was independent of lesion location or PI-RADS.
AA men were found to have similar rates of APLs on mpMRI to non-AA men indicating access to mpMRI may mitigate some of the historical racial disparity based on lesion location. AA men have increased risk of PCa detection compared to non-AA men independent of anterior location or lesion grade on mpMRI reinforcing the importance of identifying genetic, biologic, and socioeconomic drivers.
确定接受活检前多参数磁共振成像（mpMRI）的非洲裔美国（AA）男性和非 AA 男性的前前列腺病变（APL）频率是否存在差异，并评估种族和肿瘤位置对前列腺癌（PCa）检测的影响。
回顾性分析 2015 年 1 月至 2020 年 12 月 ProspectiveLoyolaUniversitympMRI（PLUM）前列腺活检队列中未诊断为 PCa 的患者的 APL 情况。多变量逻辑回归模型评估了 APL 预测因素以及 APL 和种族与任何 PCa（分级组 1+）和临床显著 PCa（csPCa；分级组 2+）检测之间的相关性。此外还进行了分层和倾向评分匹配分析。
在纳入的 1239 名男性中，190 名（15.3%）为 AA 男性，302 名（24.4%）至少有一个 APL，但在多变量分析中，种族间无差异。虽然有 APL 的男性患 PCa 或 csPCa 的可能性是两倍，但 AA 男性和非 AA 男性靶向活检证实的 APLPCa（12.6% vs 12.0%）或 csPCa（8.4% vs 8.9%）的比例相似。AA 男性在靶向核心中患前列腺癌的风险更高（OR1.66（95%CI1.06-2.61），P=0.026），这独立于病变位置或 PI-RADS。
AA 男性在 mpMRI 上的 APL 发生率与非 AA 男性相似，这表明获得 mpMRI 可能会减轻部分基于病变位置的历史种族差异。与非 AA 男性相比，AA 男性在 mpMRI 上的前位或病变分级无关的情况下，检测到 PCa 的风险增加，这进一步证实了识别遗传、生物学和社会经济驱动因素的重要性。
