Chiragzada Selin, Satya Poorvi, Macaluso Joseph N, Venkataraman Srirama S, Adams John, Nacev Aleksandar N, Kumar Dinesh
Biomedical Engineering, Columbia University, New York, USA.
Mailman School of Public Health, Columbia University, New York, USA.
Cureus. 2022 Dec 1;14(12):e32105. doi: 10.7759/cureus.32105. eCollection 2022 Dec.
Background Methods to diagnose prostate cancer (PCa), a highly prevalent disease, remain inadequate in terms of accuracy, cost, and logistical constraints for both patients and providers. Early and accurate detection of PCa is crucial to patient management, most notably in increasing quality of life and lowering cost burdens when considering the associated treatment and follow-up pathways. This article aims to discuss the impact to care pathways for nine patients whose PCa was detected by a novel Food and Drug Administration-cleared low-field magnetic resonance imager (MRI) for transperineal PCa interventions but was missed by standard-of-care systematic transrectal ultrasound (TRUS). Methodology From December 2020 to March 2022, 41 men with elevated prostate-specific antigen (PSA) levels, positive digital rectal exam findings, and Prostate Imaging Reporting & Data System scores of three or higher were enrolled. Patients first underwent targeted transperineal biopsy guided by a low-field MRI (MRIgTBx) and co-registered with T2-weighted images from a pre-procedural 3-T MRI with suspicious lesions annotated by a board-certified radiologist. Following this procedure, patients underwent standard-of-care systematic transrectal ultrasound-guided biopsy (TRUSgSBx). The entire procedure was supervised by a board-certified urologist. Results Of the 41 enrolled patients, both MRIgTBx and TRUSgSBx biopsies detected PCa in 20 patients. MRIgTBx detected PCa in an additional nine patients that were missed by TRUSgSBx. Five of the nine patients elected to pursue immediate treatment. Patients with suspected PCa and a negative biopsy return to the clinic every three to six months for PSA tests, with additional biopsies performed every year for cases with increasing PSA levels. Conclusions Early detection of PCa in nine of the 41 patients using a novel MRIgTBx method has allowed for change management resulting in an improved quality of life and cost saving for those who opted for immediate treatment. Early intervention in cases where the standard-of-care TRUSgSBx treatment was falsely negative ultimately led to a decrease in additional screening procedures, biopsies, associated tests, and an improved pathway for patient management.
背景 前列腺癌（PCa）是一种高度常见的疾病，目前用于诊断该疾病的方法在准确性、成本以及对患者和医疗服务提供者的后勤限制方面仍然存在不足。早期准确检测前列腺癌对于患者管理至关重要，尤其是在考虑相关治疗和后续随访途径时，对提高生活质量和减轻成本负担最为显著。本文旨在探讨一种新型的、已获得美国食品药品监督管理局批准的用于经会阴前列腺癌干预的低场磁共振成像仪（MRI）对9例前列腺癌患者的护理路径产生的影响，而这些患者的前列腺癌在标准护理的系统性经直肠超声检查（TRUS）中被漏诊。方法 从2020年12月至2022年3月，招募了41名前列腺特异性抗原（PSA）水平升高、直肠指检结果阳性且前列腺影像报告和数据系统（PI-RADS）评分达到3分或更高的男性。患者首先接受由低场MRI引导的靶向经会阴活检（MRI引导下经会阴活检，MRIgTBx），并与术前3-T MRI的T2加权图像共同配准，可疑病变由一名经过委员会认证的放射科医生标注。在此程序之后，患者接受标准护理的系统性经直肠超声引导活检（TRUS引导下系统性活检，TRUSgSBx）。整个程序由一名经过委员会认证的泌尿科医生监督。结果 在41名入组患者中，MRIgTBx和TRUSgSBx活检均在20名患者中检测到前列腺癌。MRIgTBx在另外9名患者中检测到前列腺癌，而这些患者被TRUSgSBx漏诊。这9名患者中有5名选择立即接受治疗。疑似前列腺癌且活检结果为阴性的患者每三到六个月返回诊所进行PSA检测，对于PSA水平升高的病例，每年进行额外的活检。结论 使用新型MRIgTBx方法在41名患者中的9名患者中早期检测到前列腺癌，使得能够进行变更管理，从而为那些选择立即治疗的患者提高了生活质量并节省了成本。在标准护理的TRUSgSBx治疗结果为假阴性的情况下进行早期干预，最终减少了额外的筛查程序、活检、相关检查，并改善了患者管理路径。
