van Riel Luigi A M J G, Jager Auke, Meijer Dennie, Postema Arnoud W, Smit Ruth S, Vis André N, de Reijke Theo M, Beerlage Harrie P, Oddens Jorg R
Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Ther Adv Urol. 2022 Mar 26;14:17562872221088536. doi: 10.1177/17562872221088536. eCollection 2022 Jan-Dec.
A pre-biopsy decision aid is needed to counsel men with a clinical suspicion for clinically significant prostate cancer (csPCa), despite normal prostate magnetic resonance imaging (MRI).
A risk calculator (RC) for csPCa (International Society of Urological Pathology grade group (ISUP) ⩾ 2) presence in men with a negative-MRI (Prostate Imaging-Reporting and Data System (PI-RADS) ⩽ 2) was developed, and its performance was compared with RCs of the European Randomized Study of Screening for Prostate Cancer (ERSPC), Prostate Biopsy Collaborative Group (PBCG), and Prospective Loyola University mpMRI (PLUM). All biopsy-naïve and prior negative biopsy men with a negative-MRI followed by systematic prostate biopsy were included from October 2015 to September 2021. The RC was developed using multivariable logistic regression with the following parameters: age (years), family history of PCa (first- or second-degree family member), ancestry (African Caribbean/other), digital rectal exam (benign/malignant), MRI field strength (1.5/3.0 Tesla), prior negative biopsy status, and prostate-specific antigen (PSA) density (ng/ml/cc). Performance of RCs was compared using receiver operating characteristic (ROC) curve analysis.
A total of 232 men were included for analysis, of which 18.1% had csPCa. Parameters associated with csPCa were family history of PCa ( < 0.0001), African Caribbean ancestry ( = 0.005), PSA density ( = 0.002), prior negative biopsy ( = 0.06), and age at biopsy ( = 0.157). The area under the curve (AUC) of the developed RC was 0.76 (95% CI 0.68-0.85). This was significantly better than the RCs of the ERSPC (AUC: 0.59; = 0.001) and PBCG (AUC: 0.60; = 0.002), yet similar to PLUM (AUC: 0.69; = 0.09).
The developed RC (Prostate Biopsy Cohort Amsterdam ('PROBA' RC), integrated predictors for csPCa at prostate biopsy in negative-MRI men and outperformed other widely used RCs. These findings require external validation before introduction in daily practice.
尽管前列腺磁共振成像（MRI）结果正常，但对于临床怀疑患有具有临床意义的前列腺癌（csPCa）的男性，仍需要一种活检前决策辅助工具来提供咨询。
开发了一种用于MRI阴性（前列腺影像报告和数据系统（PI-RADS）≤2）男性中csPCa（国际泌尿病理学会分级组（ISUP）≥2）存在情况的风险计算器（RC），并将其性能与前列腺癌筛查欧洲随机研究（ERSPC）、前列腺活检协作组（PBCG）和洛约拉大学前瞻性多参数MRI（PLUM）的RC进行比较。纳入2015年10月至2021年9月期间所有MRI阴性且未经活检以及之前活检阴性且随后接受系统性前列腺活检的男性。该RC通过多变量逻辑回归使用以下参数开发：年龄（岁）、前列腺癌家族史（一级或二级家庭成员）、血统（非洲加勒比裔/其他）、直肠指检（良性/恶性）、MRI场强（1.5/3.0特斯拉）、之前活检阴性状态以及前列腺特异性抗原（PSA）密度（ng/ml/cc）。使用受试者操作特征（ROC）曲线分析比较RC的性能。
共纳入232名男性进行分析，其中18.1%患有csPCa。与csPCa相关的参数有前列腺癌家族史（<0.0001）、非洲加勒比裔血统（=0.005）、PSA密度（=0.002）、之前活检阴性（=0.06）以及活检时年龄（=0.157）。所开发RC的曲线下面积（AUC）为0.76（95%CI 0.68 - 0.85）。这显著优于ERSPC的RC（AUC：0.59；=0.001）和PBCG的RC（AUC：0.60；=0.002），但与PLUM的RC相似（AUC：0.69；=0.09）。
所开发的RC（阿姆斯特丹前列腺活检队列（“PROBA”RC）），整合了MRI阴性男性前列腺活检时csPCa的预测因素，且性能优于其他广泛使用的RC。这些发现需要在日常实践中引入之前进行外部验证。
