Paulino Pereira Leonor J, Reesink Daan J, de Bruin Peter, Gandaglia Giorgio, van der Hoeven Erik J R J, Marra Giancarlo, Prinsen Anne, Rajwa Pawel, Soeterik Timo, Kasivisvanathan Veeru, Wever Lieke, Zattoni Fabio, van Melick Harm H E, van den Bergh Roderick C N
Department of Urology, St Antonius Hospital, 3435CM Nieuwegein, The Netherlands.
Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Cancers (Basel). 2023 Sep 29;15(19):4800. doi: 10.3390/cancers15194800.
Diagnostic pathways for prostate cancer (PCa) balance detection rates and burden. MRI impacts biopsy indication and strategy.
A prospectively collected cohort database (N = 496) of men referred for elevated PSA and/or abnormal DRE was analyzed. All underwent biparametric MRI (3 Tesla scanner) and ERSPC prostate risk-calculator. Indication for biopsy was PIRADS ≥ 3 or risk-calculator ≥ 20%. Both targeted (cognitive-fusion) and systematic cores were combined. A hypothetical full-MRI-based pathway was retrospectively studied, omitting systematic biopsies in: (1) PIRADS 1-2 but risk-calculator ≥ 20%, (2) PIRADS ≥ 3, receiving targeted biopsy-cores only.
Significant PCa (GG ≥ 2) was detected in 120 (24%) men. Omission of systematic cores in cases with PIRADS 1-2 but risk-calculator ≥ 20%, would result in 34% less biopsy indication, not-detecting 7% significant tumors. Omission of systematic cores in PIRADS ≥ 3, only performing targeted biopsies, would result in a decrease of 75% cores per procedure, not detecting 9% significant tumors. Diagnosis of insignificant PCa dropped by 52%. PCa undetected by targeted cores only, were ipsilateral to MRI-index lesions in 67%.
A biparametric MRI-guided PCa diagnostic pathway would have missed one out of six cases with significant PCa, but would have considerably reduced the number of biopsy procedures, cores, and insignificant PCa. Further refinement or follow-up may identify initially undetected cases. Center-specific data on the performance of the diagnostic pathway is required.
前列腺癌（PCa）的诊断途径需平衡检测率和负担。磁共振成像（MRI）会影响活检指征和策略。
对一个前瞻性收集的队列数据库（N = 496）进行分析，该数据库纳入了因前列腺特异性抗原（PSA）升高和/或直肠指检（DRE）异常而转诊的男性。所有患者均接受了双参数MRI（3特斯拉扫描仪）和欧洲前列腺癌筛查随机对照试验（ERSPC）前列腺风险计算器检查。活检指征为前列腺影像报告和数据系统（PIRADS）≥3或风险计算器≥20%。靶向（认知融合）活检和系统活检组织芯相结合。回顾性研究了一种基于全MRI的假设性诊断途径，在以下情况中省略系统活检：（1）PIRADS 1 - 2但风险计算器≥20%；（2）PIRADS≥3，仅接受靶向活检组织芯。
在120名（24%）男性中检测到显著前列腺癌（GG≥2）。在PIRADS 1 - 2但风险计算器≥20%的病例中省略系统活检组织芯，将导致活检指征减少34%，漏诊7%的显著肿瘤。在PIRADS≥3的病例中省略系统活检组织芯，仅进行靶向活检，将导致每次检查的组织芯数量减少75%，漏诊9%的显著肿瘤。微小前列腺癌的诊断率下降了52%。仅通过靶向组织芯未检测到的前列腺癌，67%位于MRI索引病变的同侧。
双参数MRI引导的前列腺癌诊断途径会漏诊六分之一的显著前列腺癌病例，但会大幅减少活检程序、组织芯数量和微小前列腺癌的数量。进一步优化或随访可能会发现最初未检测到的病例。需要关于诊断途径性能的中心特异性数据。
