Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Department of Urology, Urology Research Institute, The First Affiliated Hospital; Department of Urology, National Region Medical Centre, Binhai Campus of the First Affiliated Hospitalu; Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
J Cancer Res Ther. 2023 Aug;19(4):1024-1030. doi: 10.4103/jcrt.jcrt_176_23.
Accurate staging of prostate cancer (PCa) is the basis for the risk stratification to select targeted treatment. Therefore, this study aimed to compare the diagnostic accuracy rates of magnetic resonance imaging (MRI) and digital rectal examination (DRE) for preoperative T staging of potentially resectable PCa.
From March 2021 to March 2022, patients with PCa with T staging by prostate biopsy were included. All examinations used postoperative histopathologic T staging as the reference standard. All patients underwent DRE and MRI before the puncture. Two blinded urologists and radiologists independently evaluated DRE and MRI, respectively. Before the examination, patients were then divided into early- (T1, T2) and late-(T3, T4) stage cancer. Analysis of a paired sample sign test was performed to determine differences between DRE and MRI.
A total of 136 study participants with PCa were evaluated histopathologically, of whom 71% (97/136) and 29% (39/136) were at the early- and late-stage cancer, respectively. MRI had a significantly higher accuracy (91.9% vs. 76.5%, P < 0.001) compared with DRE. Further, MRI showed a higher sensitivity than DRE to diagnose early PCa (92.8% vs. 74.2%; P < 0.001). However, the specificity was not significantly different between them (89.7% vs. 82.1%; P = 0.375). Area under the curve (receiver operating curve) values were calculated as 0.78 ± 0.038 (95% confidence interval [CI], 0.71-0.86), 0.91 ± 0.028 (95% CI, 0.86-0.97), and 0.872 ± 0.028 (95% CI, 0.80-0.92) for DRE-, MRI-, MRI + DRE-based PCa predictions, respectively. The prediction performance of MRI was better than that of DRE (DeLong test, z = 3.632, P = 0.0003) and MRI + DRE (DeLong test, z = 3.715, P = 0.0002).
For resectable PCa, the diagnostic potential of MRI in assessing the T stage was higher than that of DRE. However, DRE is still valuable, especially for patients with locally advanced PCa.
准确的前列腺癌（PCa）分期是选择靶向治疗进行风险分层的基础。因此，本研究旨在比较磁共振成像（MRI）和直肠指检（DRE）在术前可切除 PCa 患者 T 分期中的诊断准确性。
本研究纳入了 2021 年 3 月至 2022 年 3 月间经前列腺活检确诊为 PCa 且具有 T 分期的患者。所有检查均以术后组织病理学 T 分期作为参考标准。所有患者在穿刺前均行 DRE 和 MRI 检查。两位盲法泌尿科医生和放射科医生分别独立评估 DRE 和 MRI。检查前，患者被分为早期（T1、T2）和晚期（T3、T4）癌症患者。采用配对样本符号检验分析 DRE 和 MRI 之间的差异。
共有 136 例 PCa 患者进行了组织病理学评估，其中 71%（97/136）和 29%（39/136）的患者分别处于早期和晚期癌症阶段。MRI 的准确性明显高于 DRE（91.9% vs. 76.5%，P<0.001）。此外，MRI 诊断早期 PCa 的灵敏度高于 DRE（92.8% vs. 74.2%；P<0.001）。然而，它们的特异性无显著差异（89.7% vs. 82.1%；P=0.375）。计算 DRE、MRI、MRI+DRE 预测 PCa 的曲线下面积（受试者工作特征曲线）值分别为 0.78±0.038（95%置信区间[CI]，0.71-0.86）、0.91±0.028（95% CI，0.86-0.97）和 0.872±0.028（95% CI，0.80-0.92）。MRI 的预测性能优于 DRE（DeLong 检验，z=3.632，P=0.0003）和 MRI+DRE（DeLong 检验，z=3.715，P=0.0002）。
对于可切除的 PCa，MRI 在评估 T 分期方面的诊断潜力高于 DRE。然而，DRE 仍然具有价值，尤其是对于局部晚期 PCa 患者。
