MRI 前列腺和前列腺健康指数在提高中国男性筛查人群中显著前列腺癌检测中的联合作用。
The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men.
机构信息
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
出版信息
Asian J Androl. 2023 Nov 1;25(6):674-679. doi: 10.4103/aja20239. Epub 2023 May 2.
Using prostate-specific antigen (PSA) for prostate cancer (PCa) screening led to overinvestigation and overdiagnosis of indolent PCa. We aimed to investigate the value of prostate health index (PHI) and magnetic resonance imaging (MRI) prostate in an Asian PCa screening program. Men aged 50-75 years were prospectively recruited from a community-based PSA screening program. Men with PSA 4.0-10.0 ng ml -1 had PHI result analyzed. MRI prostate was offered to men with PSA 4.0-50.0 ng ml -1 . A systematic prostate biopsy was offered to men with PSA 4.0-9.9 ng ml -1 and PHI ≥35, or PSA 10.0-50.0 ng ml -1 . Additional targeted prostate biopsy was offered if they had PI-RADS score ≥3. Clinically significant PCa (csPCa) was defined as the International Society of Urological Pathology (ISUP) grade group (GG) ≥2 or ISUP GG 1 with involvement of ≥30% of total systematic cores. In total, 12.8% (196/1536) men had PSA ≥4.0 ng ml -1 . Among 194 men with PSA 4.0-50.0 ng ml -1 , 187 (96.4%) received MRI prostate. Among them, 28.3% (53/187) had PI-RADS ≥3 lesions. Moreover, 7.0% (107/1536) men were indicated for biopsy and 94.4% (101/107) men received biopsy. Among the men received biopsy, PCa, ISUP GG ≥2 PCa, and csPCa was diagnosed in 42 (41.6%), 24 (23.8%), and 34 (33.7%) men, respectively. Compared with PSA/PHI pathway in men with PSA 4.0-50.0 ng ml -1 , additional MRI increased diagnoses of PCa, ISUP GG ≥2 PCa, and csPCa by 21.2% (from 33 to 40), 22.2% (from 18 to 22), and 18.5% (from 27 to 32), respectively. The benefit of additional MRI was only observed in PSA 4.0-10.0 ng ml -1 , and the number of MRI needed to diagnose one additional ISUP GG ≥2 PCa was 20 in PHI ≥35 and 94 in PHI <35. Among them, 45.4% (89/196) men with PSA ≥4.0 ng ml -1 avoided unnecessary biopsy with the use of PHI and MRI. A screening algorithm with PSA, PHI, and MRI could effectively diagnose csPCa while reducing unnecessary biopsies. The benefit of MRI prostate was mainly observed in PSA 4.0-9.9 ng ml -1 and PHI ≥35 group. PHI was an important risk stratification step for PCa screening.
使用前列腺特异性抗原（PSA）进行前列腺癌（PCa）筛查导致了惰性 PCa 的过度检查和过度诊断。我们旨在研究前列腺健康指数（PHI）和磁共振成像（MRI）前列腺在亚洲 PCa 筛查计划中的价值。从社区 PSA 筛查计划中前瞻性招募了 50-75 岁的男性。对 PSA 4.0-10.0ng/ml 的男性进行 PHI 分析。向 PSA 4.0-50.0ng/ml 的男性提供 MRI 前列腺。向 PSA 4.0-9.9ng/ml 且 PHI≥35 或 PSA 10.0-50.0ng/ml 的男性提供系统前列腺活检。如果他们的 PI-RADS 评分≥3，则提供额外的靶向前列腺活检。临床显著 PCa（csPCa）定义为国际泌尿病理学会（ISUP）分级组（GG）≥2 或 ISUP GG1 伴有≥30%的总系统核心受累。总共有 12.8%（196/1536）的男性 PSA≥4.0ng/ml。在 PSA 4.0-50.0ng/ml 的 194 名男性中，187 名（96.4%）接受了 MRI 前列腺检查。其中，28.3%（53/187）有 PI-RADS≥3 病变。此外，107/1536（7.0%）名男性需要进行活检，94.4%（101/107）名男性接受了活检。在接受活检的男性中，分别有 42 名（41.6%）、24 名（23.8%）和 34 名（33.7%）男性诊断为 PCa、ISUP GG≥2 PCa 和 csPCa。与 PSA/PHI 途径相比，PSA 4.0-50.0ng/ml 的男性中，MRI 增加了 21.2%（从 33 到 40）、22.2%（从 18 到 22）和 18.5%（从 27 到 32）的 PCa、ISUP GG≥2 PCa 和 csPCa 诊断。MRI 的获益仅在 PSA 4.0-10.0ng/ml 中观察到，在 PHI≥35 时，诊断额外的 1 例 ISUP GG≥2 PCa 需要进行 20 次 MRI，在 PHI<35 时需要进行 94 次 MRI。其中，PSA≥4.0ng/ml 的 196 名男性中有 45.4%（89/196）避免了使用 PHI 和 MRI 进行不必要的活检。使用 PSA、PHI 和 MRI 的筛查算法可以有效诊断 csPCa，同时减少不必要的活检。MRI 前列腺的获益主要在 PSA 4.0-9.9ng/ml 和 PHI≥35 组中观察到。PHI 是 PCa 筛查的重要风险分层步骤。
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