Byun Hye J, Shin Teak J, Jung Wonho, Ha Ji Y, Kim Byung H, Kim Young H
Department of Urology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea.
Department of Radiology, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea.
Prostate Int. 2022 Mar;10(1):45-49. doi: 10.1016/j.prnil.2021.10.002. Epub 2021 Nov 4.
To evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear.
We retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA <4, 4-10, >10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared.
Data from a total of 670 males were included in the analysis (standard TRUS, = 333; MRI/US fusion, = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4-10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, = 0.033). However, patients with PSA <4 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (12.0% vs. 16.0%, = 0.342), whereas, patients with PSA >10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31-4.60, = 0.005) were significantly associated with a detection of csPCa.
Detection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naïve men with PSA 4-10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA <4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations.
评估在初次活检的男性患者中，磁共振成像和超声（MRI/US）融合活检对临床显著前列腺癌（csPCa）的检出率，这些患者具有不同的前列腺特异性抗原（PSA）水平。由于与标准经直肠超声（TRUS）引导活检相比，MRI能够有效检测csPCa；然而，其使用的最佳PSA阈值尚不清楚。
我们回顾性分析了2016年1月至2018年6月期间接受MRI/US融合活检和标准活检的患者。患者分为三组：PSA<4、4-10、>10 ng/mL。进行倾向评分以平衡不同活检组的特征，并比较csPCa的检出率。
共有670名男性的数据纳入分析（标准TRUS，n = 333；MRI/US融合，n = 337）。在匹配之前，接受MRI/US融合活检的患者前列腺体积较小。倾向评分匹配平衡了这一特征，并产生了每组195名患者的队列。在匹配队列中，PSA为4-10 ng/mL的患者通过MRI/US融合活检检测到csPCa的风险显著高于标准活检（35.0%对26.6%，P = 0.033）。然而，PSA<4 ng/mL的患者通过MRI/US融合活检与标准活检发现csPCa的情况（12.0%对16.0%，P = 0.342），而PSA>10 ng/mL的患者通过MRI/US融合活检与标准活检发现csPCa的情况（78.0%对80.0%，P = 0.596）。在PSA为4-10 ng/mL的患者的多因素逻辑分析中，MRI/US融合活检（优势比：2.46，95%置信区间 = 1.31-4.6, P = 0.005）与csPCa的检测显著相关。
对于初次活检且PSA为4-10 ng/mL的男性患者，MRI/US融合活检检测csPCa更有效。然而，标准TRUS活检可能在PSA<4 ng/mL和≥10 ng/mL的患者中识别出csPCa，强调了在此类人群中结合标准活检与MRI/US融合活检的重要性。
