Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA.
Institute for Precision Health, UCLA, Los Angeles, CA, USA.
Prostate Cancer Prostatic Dis. 2024 Mar;27(1):65-72. doi: 10.1038/s41391-022-00591-w. Epub 2022 Sep 12.
Protocol-based active surveillance (AS) biopsies have led to poor compliance. To move to risk-based protocols, more accurate imaging biomarkers are needed to predict upgrading on AS prostate biopsy. We compared restriction spectrum imaging (RSI-MRI) generated signal maps as a biomarker to other available non-invasive biomarkers to predict upgrading or reclassification on an AS biopsy.
We prospectively enrolled men on prostate cancer AS undergoing repeat biopsy from January 2016 to June 2019 to obtain an MRI and biomarkers to predict upgrading. Subjects underwent a prostate multiparametric MRI and a short duration, diffusion-weighted enhanced MRI called RSI to generate a restricted signal map along with evaluation of 30 biomarkers (14 clinico-epidemiologic features, 9 molecular biomarkers, and 7 radiologic-associated features). Our primary outcome was upgrading or reclassification on subsequent AS prostate biopsy. Statistical analysis included operating characteristic improvement using AUROC and AUPRC.
The individual biomarker with the highest area under the receiver operator characteristic curve (AUC) was RSI-MRI (AUC = 0.84; 95% CI: 0.71-0.96). The best non-imaging biomarker was prostate volume-corrected Prostate Health Index density (PHI, AUC = 0.68; 95% CI: 0.53-0.82). Non-imaging biomarkers had a negligible effect on predicting upgrading at the next biopsy but did improve predictions of overall time to progression in AS.
RSI-MRI, PIRADS, and PHI could improve the predictive ability to detect upgrading in AS. The strongest predictor of clinically significant prostate cancer on AS biopsy was RSI-MRI signal output.
基于方案的主动监测 (AS) 活检导致了较差的依从性。为了转向基于风险的方案，需要更准确的成像生物标志物来预测 AS 前列腺活检中的升级。我们比较了限制频谱成像 (RSI-MRI) 生成的信号图作为生物标志物，以预测 AS 活检中的升级或重新分类。
我们前瞻性地招募了 2016 年 1 月至 2019 年 6 月期间接受 AS 前列腺活检的前列腺癌患者，以获得 MRI 和生物标志物来预测升级。患者接受了前列腺多参数 MRI 和称为 RSI 的短时间弥散加权增强 MRI，以生成受限信号图，同时评估 30 个生物标志物（14 个临床流行病学特征、9 个分子生物标志物和 7 个放射学相关特征）。我们的主要结局是后续 AS 前列腺活检中的升级或重新分类。统计分析包括使用 AUROC 和 AUPRC 评估操作特征的改善。
个体生物标志物中 AUC 最高的是 RSI-MRI（AUC=0.84；95%CI：0.71-0.96）。最佳非成像生物标志物是前列腺体积校正前列腺健康指数密度（PHI，AUC=0.68；95%CI：0.53-0.82）。非成像生物标志物对下一次活检中升级的预测作用可以忽略不计，但确实改善了 AS 中总体进展时间的预测。
RSI-MRI、PIRADS 和 PHI 可以提高检测 AS 中升级的预测能力。AS 活检中临床上显著前列腺癌的最强预测因子是 RSI-MRI 信号输出。
