Camacho Andrés, Salah Fatima, Bay Camden P, Waring Jonathan, Umeton Renato, Hirsch Michelle S, Cole Alexander P, Kibel Adam S, Loda Massimo, Tempany Clare M, Fennessy Fiona M
Department of Radiology Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA.
Department of Informatics and Analytics, Dana-Farber Cancer Institute Harvard Medical School Boston Massachusetts USA.
BJUI Compass. 2023 Apr 11;4(4):473-481. doi: 10.1002/bco2.231. eCollection 2023 Jul.
The study aims to propose an optimal workflow in patients with a PI-RADS 3 (PR-3) assessment category (AC) through determining the timing and type of pathology interrogation used for the detection of clinically significant prostate cancer (csPCa) in these men based upon a 5-year retrospective review in a large academic medical center.
This United States Health Insurance Probability and Accountability Act (HIPAA)-compliant, institutional review board-approved retrospective study included men without prior csPCa diagnosis who received PR-3 AC on magnetic resonance (MR) imaging (MRI). Subsequent incidence and time to csPCa diagnosis and number/type of prostate interventions was recorded. Categorical data were compared using Fisher's exact test and continuous data using ANOVA omnibus -test.
Our cohort of 3238 men identified 332 who received PR-3 as their highest AC on MRI, 240 (72.3%) of whom had pathology follow-up within 5 years. csPCa was detected in 76/240 (32%) and non-csPCa in 109/240 (45%) within 9.0 ± 10.6 months. Using a non-targeted trans-rectal ultrasound biopsy as the initial approach ( = 55), another diagnostic procedure was required to diagnose csPCa in 42/55 (76.4%) of men, compared with 3/21(14.3%) men with an initial MR targeted-biopsy approach ( = 21); ( < 0.0001). Those with csPCa had higher median serum prostate-specific antigen (PSA) and PSA density, and lower median prostate volume ( < 0.003) compared with non-csPCa/no PCa.
Most patients with PR-3 AC underwent prostate pathology exams within 5 years, 32% of whom were found to have csPCa within 1 year of MRI, most often with a higher PSA density and a prior non-csPCa diagnosis. Addition of a targeted biopsy approach initially reduced the need for a second biopsy to reach a for csPCa diagnosis. Thus, a combination of systematic and targeted biopsy is advised in men with PR-3 and a co-existing abnormal PSA and PSA density.
本研究旨在通过对一家大型学术医疗中心5年的回顾性研究，确定用于检测这些男性临床显著前列腺癌（csPCa）的病理检查时机和类型，从而为PI-RADS 3（PR-3）评估类别（AC）的患者提出最佳工作流程。
这项符合美国《健康保险流通与责任法案》（HIPAA）且经机构审查委员会批准的回顾性研究纳入了既往未诊断csPCa且磁共振成像（MRI）检查为PR-3 AC的男性。记录随后的csPCa诊断发生率、时间以及前列腺干预的数量/类型。分类数据采用Fisher精确检验进行比较，连续数据采用方差分析综合检验。
我们的3238名男性队列中，有332人在MRI检查中最高AC为PR-3，其中240人（72.3%）在5年内接受了病理随访。在9.0±10.6个月内，76/240（32%）被检测出患有csPCa，109/240（45%）为非csPCa。以非靶向经直肠超声活检作为初始方法（n = 55）时，42/55（76.4%）的男性需要另一种诊断程序来诊断csPCa，而初始采用MR靶向活检方法的男性中这一比例为3/21（14.3%）（n = 21）；（P < 0.0001）。与非csPCa/无PCa患者相比，csPCa患者的血清前列腺特异性抗原（PSA）和PSA密度中位数更高，前列腺体积中位数更低（P < 0.003）。
大多数PR-3 AC患者在5年内接受了前列腺病理检查，其中32%在MRI检查后1年内被发现患有csPCa，多数患者PSA密度较高且既往有非csPCa诊断。最初采用靶向活检方法减少了为诊断csPCa而进行二次活检的需求。因此，对于PR-3且同时存在PSA和PSA密度异常的男性，建议采用系统活检和靶向活检相结合的方法。
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