PSA 密度对于前列腺 MRI PI-RADS 评分系统在临床上有意义的前列腺癌风险分层具有互补作用。
PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer.
机构信息
Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Urology, Yale School of Medicine, New Haven, CT, USA.
出版信息
Prostate Cancer Prostatic Dis. 2023 Jun;26(2):347-352. doi: 10.1038/s41391-022-00549-y. Epub 2022 May 6.
BACKGROUND
While prostate multiparametric-magnetic resonance imaging (MP-MRI) has improved the diagnosis of clinically significant prostate cancer (CSPC), the complementary use of prostate-specific antigen (PSA) levels to risk-stratify for CSPC requires further study. The objective of this project was to determine if prostate MP-MRI and PSA can provide complementary insights into CSPC risk stratification.
METHODS
In an IRB-approved study, pathologic outcomes from patients who underwent MR/US fusion-targeted prostate biopsy were stratified by various parameters including PSA, PSA density (PSAD), age, race, and PI-RADS v2 score. CSPC was defined as a Gleason score ≥7. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals (CI). P values were reported as two-sided with p < 0.05 considered statistically significant. ROC curves were generated for assessing the predictive value of tests and sensitivity + specificity optimization was performed to determine optimal testing cutoffs.
RESULTS
A total of 327 patients with 709 lesions total were analyzed. PSAD and PI-RADS scores provided complementary predictive value for diagnosis of CSPC (AUC PSAD: 0.67, PI-RADS: 0.72, combined: 0.78, p < 0.001). When controlling for PI-RADS score, age, and race, multivariate analysis showed that PSAD was independently associated with CSPC (OR 1.03 per 0.01 PSAD increase, 95% CI 1.02-105, p < 0.001). The optimal cutoff of PSAD ≥ 0.1 ng/ml/cc shows that a high versus low PSAD was roughly equivalent to an increase in 1 in PI-RADS score for the presence of CSPC (4% of PI-RADS ≤3 PSAD low, 6% of PI-RADS 3 PSAD high vs. 5% of PI-RADS 4 PSAD low, 22% of PI-RADS 4 PSAD high vs. 29% of PI-RADS 5 PSAD low, 46% of PI-RADS 5 PSAD high were found to have CSPC).
CONCLUSIONS
PSAD with a cutoff of 0.1 ng/ml/cc appears to be a useful marker that can stratify the risk of CSPC in a complementary manner to prostate MP-MRI.
背景
虽然前列腺多参数磁共振成像（MP-MRI）提高了临床显著前列腺癌（CSPC）的诊断水平，但为了对 CSPC 进行风险分层，仍需要进一步研究前列腺特异性抗原（PSA）水平的补充作用。本项目的目的是确定前列腺 MP-MRI 和 PSA 是否可以为 CSPC 风险分层提供互补的见解。
方法
在一项经 IRB 批准的研究中，根据 PSA、PSA 密度（PSAD）、年龄、种族和 PI-RADS v2 评分等各种参数对接受 MR/US 融合靶向前列腺活检的患者的病理结果进行分层。CSPC 的定义为 Gleason 评分≥7。使用逻辑回归确定优势比（OR）及其 95%置信区间（CI）。p 值以双侧报告，p<0.05 被认为具有统计学意义。ROC 曲线用于评估测试的预测值，并进行了灵敏度+特异性优化以确定最佳测试截止值。
结果
共分析了 327 名患者的 709 个病灶。PSAD 和 PI-RADS 评分对 CSPC 的诊断具有互补的预测价值（PSAD 的 AUC：0.67，PI-RADS：0.72，联合：0.78，p<0.001）。在控制 PI-RADS 评分、年龄和种族后，多变量分析表明 PSAD 与 CSPC 独立相关（每增加 0.01 PSAD，OR 为 1.03，95%CI 为 1.02-105，p<0.001）。PSAD≥0.1ng/ml/cc 的最佳截止值表明，高 PSAD 与 PI-RADS 评分增加 1 分大致相当，与 CSPC 的存在相关（PI-RADS≤3 PSAD 低的为 4%，PI-RADS 3 PSAD 高的为 6%，PI-RADS 4 PSAD 低的为 5%，PI-RADS 4 PSAD 高的为 22%，PI-RADS 5 PSAD 低的为 46%，PI-RADS 5 PSAD 高的为 29%）。
结论
PSAD 的截止值为 0.1ng/ml/cc 似乎是一种有用的标志物，可以与前列腺 MP-MRI 以互补的方式对 CSPC 的风险进行分层。
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