de Vos Ivo I, Drost Frank-Jan H, Bokhorst Leonard P, Alberts Arnout R, van Gelder Martine, Herman Erik M, Boswinkel Wouter D, Bangma Chris H, Roobol Monique J
Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
Transl Androl Urol. 2023 Feb 28;12(2):241-248. doi: 10.21037/tau-22-640. Epub 2023 Feb 1.
Our objective was to assess the accuracy of transabdominal ultrasound (TAUS) measured prostate volume in the primary care setting with transrectal ultrasound (TRUS) measured prostate volume by the urologist as the reference test. Furthermore, our objective was to assess whether risk-stratification using TAUS prostate volume by the primary care physician could reduce unnecessary referrals to the urologist.
Men in two Dutch primary care offices with a prostate cancer (PCa) screening request received a digital rectal examination (DRE), prostate specific-antigen (PSA), and TAUS prostate volume measurement by the general practitioner, followed by Rotterdam Prostate Cancer Risk Calculator (RPCRC) risk assessment. The examination was repeated by a urologist using TRUS. A prostate biopsy was performed in case of a RPCRC positive biopsy advice. A non-inferiority analysis was performed comparing TAUS and TRUS prostate volume differences. A risk-based referral strategy using TAUS and the RPCRC in the primary care setting was compared with the standard referral strategy based on PSA (≥3 ng/mL) and DRE.
A total of 105 men were included with a median PSA of 1.9 ng/mL. The mean prostate volumes measured by TAUS and TRUS were 55 and 45 mL, respectively. The mean overestimation of the prostate volume by TAUS as compared to the reference test was 9.9 mL (95% CI: 5.9-13.8). According to Dutch standard practice, 41 out of 105 (39%) men would have been referred to the urologist. Stratification in primary care based on the RPCRC using TAUS prostate volume would have avoided 29 out of the 41 (71%) referrals, at the expense of non-referral of 5 out of 11 (45%) men with a biopsy indication, according to the urologist.
RPCRC-based risk stratification in primary care using TAUS prostate volume measurement is feasible and may prevent unnecessary referrals to the urologist and reduce costs. The accuracy of the risk assessment with TAUS might be improved by sufficient training and centralization to achieve a higher volume of consultations in primary care facilities.
我们的目标是，以泌尿科医生经直肠超声（TRUS）测量的前列腺体积作为参考标准，评估在初级保健机构中经腹超声（TAUS）测量前列腺体积的准确性。此外，我们的目标是评估初级保健医生使用TAUS前列腺体积进行风险分层是否可以减少不必要的泌尿科转诊。
荷兰两家初级保健机构中因前列腺癌（PCa）筛查需求而来的男性接受了全科医生的直肠指检（DRE）、前列腺特异性抗原（PSA）检测以及TAUS前列腺体积测量，随后进行鹿特丹前列腺癌风险计算器（RPCRC）风险评估。泌尿科医生使用TRUS重复进行检查。如果RPCRC给出活检建议，则进行前列腺活检。对TAUS和TRUS测量的前列腺体积差异进行非劣效性分析。将初级保健机构中使用TAUS和RPCRC的基于风险的转诊策略与基于PSA（≥3 ng/mL）和DRE的标准转诊策略进行比较。
共纳入105名男性，PSA中位数为1.9 ng/mL。TAUS和TRUS测量的平均前列腺体积分别为55 mL和45 mL。与参考检测相比，TAUS对前列腺体积的平均高估为9.9 mL（95%置信区间：5.9 - 13.8）。根据荷兰的标准做法，105名男性中有41名（39%）会被转诊至泌尿科。根据泌尿科医生的说法，在初级保健机构中基于RPCRC使用TAUS前列腺体积进行分层，原本41名转诊患者中的29名（71%）可以避免转诊，但代价是11名有活检指征的男性中有5名（45%）未被转诊。
在初级保健机构中使用TAUS前列腺体积测量进行基于RPCRC的风险分层是可行的，可能会避免不必要的泌尿科转诊并降低成本。通过充分培训和集中化以在初级保健机构实现更高的会诊量，TAUS风险评估的准确性可能会得到提高。
