Tufts University School of Medicine, Boston, Massachusetts, USA.
Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
Prostate. 2022 Feb;82(3):352-358. doi: 10.1002/pros.24280. Epub 2021 Dec 8.
Prostate Imaging Reporting and Data System (PI-RADS) scores can help identify clinically significant prostate cancer and improve patient selection for prostate biopsies. However, the role of PI-RADS scores in patients already diagnosed with prostate cancer remains unclear. The purpose of this study was to evaluate the association of PI-RADS scores with prostate cancer upstaging. Upstaging on final pathology harbors a higher risk for biochemical recurrence with important implications for additional treatments, morbidity, and mortality.
All patients from a single high-volume institution who underwent a prostate multiparametric magnetic resonance imaging and radical prostatectomy between 2016 and 2020 were included in this retrospective analysis. Univariable and multivariable analyses were conducted to investigate potential associations with upstaging events, defined by pT3, pT4, or N1 on final pathology. A logistic regression model was constructed for the prediction of upstaging events based on PI-RADS score, prostate-specific antigen density (PSA-D), and biopsy Gleason grade groups. We built receiver operative characteristic (ROC) curves to measure the area under the curve of different predictive models.
Two hundred and ninety-four patients were included in the final analysis. Upstaging events occurred in 137 (46.5%) of patients. On univariable analysis, patients who were upstaged on final pathology had significantly higher PI-RADS scores (odds ratio [OR] 2.34 95% confidence interval [CI] 1.64-3.40, p < 0.001) but similar PSA-D (OR 2.70 95% 0.94-8.43, p = 0.188) compared with patients who remained pT1 or pT2 on final pathology. On multivariable analysis, PI-RADS remained independently significantly associated with upstaging, suggesting it is an independent risk predictor for upstaging. Lymph node metastasis only occurred in patients with PI-RADS 4 or 5 lesions (n = 15). Our model using PSA-D, biopsy Gleason grade, and PI-RADS had a predictive AUC of 0.69 for upstaging events, an improvement from 0.59 using biopsy Gleason grade alone.
PI-RADS scores are independent predictors for upstaging events and may play an important role in forecasting biochemical recurrence and lymph node metastasis. Modern nomograms should be updated to include PI-RADS to predict lymph node metastases and the likelihood of biochemical recurrence more accurately.
前列腺影像报告和数据系统（PI-RADS）评分有助于识别具有临床意义的前列腺癌并改善前列腺活检的患者选择。然而，PI-RADS 评分在已经诊断为前列腺癌的患者中的作用尚不清楚。本研究的目的是评估 PI-RADS 评分与前列腺癌升级之间的关联。最终病理上的升级具有更高的生化复发风险，这对进一步的治疗、发病率和死亡率有重要影响。
本回顾性分析纳入了 2016 年至 2020 年间在单一高容量机构接受前列腺多参数磁共振成像和根治性前列腺切除术的所有患者。进行单变量和多变量分析，以调查与最终病理上 pT3、pT4 或 N1 相关的升级事件的潜在关联。基于 PI-RADS 评分、前列腺特异性抗原密度（PSA-D）和活检 Gleason 分级组，构建了一个用于预测升级事件的逻辑回归模型。我们构建了接收器工作特征（ROC）曲线，以测量不同预测模型的曲线下面积。
最终有 294 名患者纳入最终分析。137 名（46.5%）患者发生升级事件。在单变量分析中，最终病理升级的患者 PI-RADS 评分明显更高（优势比 [OR] 2.34，95%置信区间 [CI] 1.64-3.40，p<0.001），但 PSA-D 相似（OR 2.70，95%CI 0.94-8.43，p=0.188）与最终病理仍为 pT1 或 pT2 的患者相比。在多变量分析中，PI-RADS 仍然与升级事件独立显著相关，表明它是升级事件的独立风险预测因子。淋巴结转移仅发生在 PI-RADS 4 或 5 病变的患者中（n=15）。我们使用 PSA-D、活检 Gleason 分级和 PI-RADS 的模型对升级事件的预测 AUC 为 0.69，优于仅使用活检 Gleason 分级的 0.59。
PI-RADS 评分是升级事件的独立预测因子，可能在预测生化复发和淋巴结转移方面发挥重要作用。现代列线图应更新，以更准确地预测淋巴结转移和生化复发的可能性，包括 PI-RADS。
