Department of Urology, National University Hospital, Singapore, Singapore.
Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore.
BMC Urol. 2023 Apr 15;23(1):61. doi: 10.1186/s12894-023-01235-4.
Magnetic resonance imaging (MRI) scans are increasingly first-line investigations for suspected prostate cancer, and essential in the decision for biopsy. 5-alpha reductase inhibitor (5-ARI) use has been shown to reduce prostate size and prostate cancer risk. However, insufficient data exists on how 5-ARI use affects MRI findings and yield of biopsy. This study explores the differences in imaging and prostate cancer diagnoses between patients receiving and not receiving 5-ARI therapy.
From 2015 to 2020, we collected retrospective data of consecutive patients undergoing prostate biopsy at one centre. We included patients who were biopsy-naïve, had prior negative biopsies, or on active surveillance for low-grade prostate cancer. Clinical and pathological data was collected, including 5-ARI use, Prostate Imaging Reporting and Data System (PIRADS) classification and biopsy results.
351 men underwent saturation biopsy with or without targeted biopsies. 54 (15.3%) had a history of 5-ARI use. On mpMRI, there was no significant difference between the 5ARI and non-5-ARI groups in PIRADS distribution, number of lesions, and lesion location. Significantly fewer cancers were detected in the 5-ARI group (46.3% vs. 68.0%; p < 0.01). There were no significant differences in PIRADS distribution in 5-ARI patients with positive and negative biopsy.
Our study found significant differences in biochemical, imaging and biopsy characteristics between 5-ARI and non-5-ARI groups. While both groups had similar PIRADS distribution, 5-ARI patients had a lower rate of positive biopsies across all PIRADS categories, which may suggest that the use of 5ARI may confound MRI findings. Further studies on how 5-ARI therapy affects the imaging characteristics of prostate cancer should be performed.
磁共振成像（MRI）扫描越来越成为疑似前列腺癌的一线检查方法，对活检决策至关重要。5α-还原酶抑制剂（5-ARI）的使用已被证明可以缩小前列腺体积并降低前列腺癌的风险。然而，关于 5-ARI 使用如何影响 MRI 结果和活检的检出率，目前的数据还不够充分。本研究旨在探讨接受和未接受 5-ARI 治疗的患者之间在影像学表现和前列腺癌诊断方面的差异。
我们从 2015 年至 2020 年，在一家中心收集了连续接受前列腺活检的患者的回顾性数据。我们纳入了初次活检、既往阴性活检或因低级别前列腺癌而接受主动监测的患者。收集了包括 5-ARI 使用情况、前列腺影像报告和数据系统（PIRADS）分类以及活检结果在内的临床和病理数据。
351 名男性接受了饱和活检和/或靶向活检。54 名（15.3%）患者有 5-ARI 使用史。在 mpMRI 上，5-ARI 组和非 5-ARI 组之间 PIRADS 分布、病变数量和病变位置无显著差异。5-ARI 组的癌症检出率显著较低（46.3% vs. 68.0%；p<0.01）。5-ARI 阳性和阴性活检患者的 PIRADS 分布无显著差异。
我们的研究发现 5-ARI 和非 5-ARI 组之间在生化、影像学和活检特征方面存在显著差异。尽管两组的 PIRADS 分布相似，但 5-ARI 患者在所有 PIRADS 类别中阳性活检率均较低，这可能表明 5-ARI 的使用可能会影响 MRI 结果。应该进行进一步的研究，以了解 5-ARI 治疗如何影响前列腺癌的影像学特征。
