Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy.
Curr Oncol. 2023 May 12;30(5):4957-4965. doi: 10.3390/curroncol30050374.
PSA density and an elevated PI-RADS score are among the strongest predictors of prostate cancer (PCa) in a fusion biopsy. Positive family history, hypertension, diabetes, and obesity have also been associated with the risk of developing PCa. We aim to identify predictors of the prostate cancer detection rate (CDR) in a series of patients undergoing a fusion biopsy.
We retrospectively evaluated 736 consecutive patients who underwent an elastic fusion biopsy from 2020 to 2022. Targeted biopsies (2-4 cores per MRI target) were followed by systematic mapping (10-12 cores). Clinically significant PCa (csPCa) was defined as ISUP score ≥ 2. Uni- and multi-variable logistic regression analyses were performed to identify predictors of CDR among age, body mass index (BMI), hypertension, diabetes, positive family history, PSA, a positive digital rectal examination (DRE), PSA density ≥ 0.15, previous negative biopsy status, PI-RADS score, and size of MRI lesion.
The median patients' age was 71 years, and median PSA was 6.6 ng/mL. A total of 20% of patients had a positive digital rectal examination. Suspicious lesions in mpMRI were scored as 3, 4, and 5 in 14.9%, 55.0%, and 17.5% of cases, respectively. The CDR was 63.2% for all cancers and 58.7% for csPCa. Only age (OR 1.04, < 0.001), a positive DRE (OR 1.75, 0.04), PSA density (OR 2.68, < 0.001), and elevated PI-RADS score (OR 4.02, = 0.003) were significant predictors of the CDR in the multivariable analysis for overall PCa. The same associations were found for csPCa. The size of an MRI lesion was associated with the CDR only in uni-variable analysis (OR 1.07, < 0.001). BMI, hypertension, diabetes, and a positive family history were not predictors of PCa.
In a series of patients selected for a fusion biopsy, positive family history, hypertension, diabetes, or BMI are not predictors of PCa detection. PSA-density and PI-RADS score are confirmed to be strong predictors of the CDR.
在融合活检中，PSA 密度和升高的 PI-RADS 评分是前列腺癌（PCa）最强的预测因素之一。阳性家族史、高血压、糖尿病和肥胖也与 PCa 发病风险相关。我们旨在确定一系列接受融合活检患者的前列腺癌检出率（CDR）的预测因素。
我们回顾性评估了 2020 年至 2022 年期间接受弹性融合活检的 736 例连续患者。靶向活检（每 MRI 靶位 2-4 个核心）后进行系统图谱（10-12 个核心）。临床显著前列腺癌（csPCa）定义为 ISUP 评分≥2。采用单变量和多变量逻辑回归分析，确定年龄、体重指数（BMI）、高血压、糖尿病、阳性家族史、PSA、阳性直肠指检（DRE）、PSA 密度≥0.15、先前阴性活检史、PI-RADS 评分和 MRI 病变大小等因素与 CDR 的关系。
患者中位年龄为 71 岁，中位 PSA 为 6.6ng/mL。20%的患者直肠指检阳性。mpMRI 中的可疑病变分别在 14.9%、55.0%和 17.5%的病例中评分为 3、4 和 5。所有癌症的 CDR 为 63.2%，csPCa 为 58.7%。仅年龄（OR1.04，<0.001）、DRE 阳性（OR1.75，0.04）、PSA 密度（OR2.68，<0.001）和升高的 PI-RADS 评分（OR4.02，=0.003）是多变量分析中总体 PCa 的 CDR 的显著预测因素。csPCa 也有同样的关联。MRI 病变大小仅在单变量分析中与 CDR 相关（OR1.07，<0.001）。BMI、高血压、糖尿病和阳性家族史与 PCa 无关。
在一系列选择接受融合活检的患者中，阳性家族史、高血压、糖尿病或 BMI 不是 PCa 检测的预测因素。PSA 密度和 PI-RADS 评分被证实是 CDR 的强有力预测因素。
