Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
World J Urol. 2024 Mar 20;42(1):182. doi: 10.1007/s00345-024-04894-6.
In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, "PI-RADS 5 patients").
PI-RADS 5 patients who underwent MRI/Ultrasound fusion biopsy (Bx) between 2016 and 2020 were identified in our institutional database. Uni- and multivariable logistic-regression models were used to identify predictors of csPCA-detection (GGG ≥ 2). Risk models were adjusted for ECE, PSA-D, and cT-stage. Corresponding Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were calculated.
Among 493 consecutive PI-RADS 5 patients, the median age and PSA was 69 years (IQR 63-74) and 8.9 ng/ml (IQR 6.0-13.7), respectively. CsPCA (GGG ≥ 2) was detected in 405/493 (82%); 36/493 patients (7%) had no cancer. When tabulating for PSA-D of > 0.2 ng/ml/cc and > 0.5 ng/ml/cc, csPCA was found in 228/253 (90%, PI-RADS5 + PSA-D > 0.2 ng/ml/cc) and 54/54 (100%, PI-RADS5 + PSA-D > 0.5 ng/ml/cc). Finally, a model incorporating PSA-D and cT-stage achieved an AUC of 0.79 (CI 0.74-0.83).
In PI-RADS 5 patients, PSA-D and cT-stage emerged as strong predictors of csPCA at biopsy. Moreover, when adding the threshold of PSA-D > 0,5 ng/ml/cc, all PI-RADS 5 patients were diagnosed with csPCA. Therefore, straight treatment for PCA can be considered, especially if risk-factors for biopsy-related complications such as obligatory dual platelet inhibition are present.
与其他恶性肿瘤不同，对于临床显著前列腺癌（csPCA）高度怀疑的患者，在治疗前通常需要进行组织学确认。本研究旨在分析在至少存在一个 PI-RADS 5 病变的患者（以下简称“PI-RADS 5 患者”）中，包膜外侵犯（ECE）、经直肠指检（DRE）定义的 cT 分期和 PSA 密度（PSA-D）对 csPCA 检测的影响。
我们在机构数据库中确定了 2016 年至 2020 年间接受 MRI/超声融合活检（Bx）的 PI-RADS 5 患者。采用单变量和多变量逻辑回归模型来识别 csPCA 检测的预测因子（GGG≥2）。风险模型调整了 ECE、PSA-D 和 cT 分期。计算相应的受试者工作特征（ROC）曲线和曲线下面积（AUC）。
在 493 例连续的 PI-RADS 5 患者中，中位年龄和 PSA 分别为 69 岁（IQR 63-74）和 8.9ng/ml（IQR 6.0-13.7）。在 493 例患者中，405 例（82%）检测到 csPCA（GGG≥2）；36 例（7%）患者无癌症。当 PSA-D 值分别大于 0.2ng/ml/cc 和 0.5ng/ml/cc 时，253 例患者中有 228 例（90%，PI-RADS5+PSA-D＞0.2ng/ml/cc）和 54 例（100%，PI-RADS5+PSA-D＞0.5ng/ml/cc）发现 csPCA。最后，纳入 PSA-D 和 cT 分期的模型 AUC 为 0.79（CI 0.74-0.83）。
在 PI-RADS 5 患者中，PSA-D 和 cT 分期是活检时 csPCA 的重要预测因素。此外，当 PSA-D 值大于 0.5ng/ml/cc 时，所有 PI-RADS 5 患者均被诊断为 csPCA。因此，对于这些患者可以考虑直接进行 PCA 治疗，特别是如果存在活检相关并发症的风险因素（如必须双重血小板抑制）。
