Department of Urology, NYU Langone Medical Center, New York, NY, USA.
BJU Int. 2024 Jul;134(1):128-135. doi: 10.1111/bju.16341. Epub 2024 Mar 27.
To evaluate the interaction of patient age and Prostate Imaging-Reporting and Data System (PI-RADS) score in determining the grade of prostate cancer (PCa) identified on magnetic resonance imaging (MRI)-targeted biopsy in older men.
From a prospectively accrued Institutional Review Board-approved comparative study of MRI-targeted and systematic biopsy between June 2012 and December 2022, men with at least one PI-RADS ≥3 lesion on pre-biopsy MRI and no prior history of PCa were selected. Ordinal and binomial logistic regression analyses were performed.
A total of 2677 men met study criteria. The highest PI-RADS score was 3 in 1220 men (46%), 4 in 950 men (36%), and 5 in 507 men (19%). The median (interquartile range [IQR]) patient age was 66.7 (60.8-71.8) years, median (IQR) prostate-specific antigen (PSA) level was 6.1 (4.6-9.0) ng/mL, median (IQR) prostate volume was 48 (34-68) mL, and median (IQR) PSA density was 0.13 (0.08-0.20) ng/mL/mL. Clinically significant (cs)PCa and high-risk PCa were identified on targeted biopsy in 1264 (47%) and 321 (12%) men, respectively. Prevalence of csPCa and high-risk PCa were significantly higher in the older age groups. On multivariable analyses, patient age was significantly associated with csPCa but not high-risk PCa; PI-RADS score and the interaction of age and PI-RADS score were significantly associated with high-risk PCa but not csPCa.
In our cohort, the substantial rate of high-risk PCa on MRI-ultrasound fusion targeted biopsies in older men, and its significant association with MRI findings, supports the value of pre-biopsy MRI to localise disease that could cause cancer mortality even in older men.
评估患者年龄与前列腺影像报告和数据系统（PI-RADS）评分在预测磁共振成像（MRI）靶向活检中识别的老年男性前列腺癌（PCa）分级中的相互作用。
本研究为 2012 年 6 月至 2022 年 12 月前瞻性收集的机构审查委员会批准的 MRI 靶向和系统活检的比较研究，选择了至少有一个术前 MRI 上的 PI-RADS≥3 病变且无 PCa 病史的男性。进行了有序和二项逻辑回归分析。
共有 2677 名男性符合研究标准。最高 PI-RADS 评分为 3 分的有 1220 名男性（46%），4 分的有 950 名男性（36%），5 分的有 507 名男性（19%）。患者年龄中位数（四分位距 [IQR]）为 66.7（60.8-71.8）岁，中位（IQR）前列腺特异性抗原（PSA）水平为 6.1（4.6-9.0）ng/ml，中位（IQR）前列腺体积为 48（34-68）ml，中位（IQR）PSA 密度为 0.13（0.08-0.20）ng/ml/ml。靶向活检中发现临床显著（cs）PCa 和高危 PCa 分别为 1264 名（47%）和 321 名（12%）男性。在年龄较大的年龄组中，csPCa 和高危 PCa 的患病率显著较高。多变量分析显示，患者年龄与 csPCa 显著相关，但与高危 PCa 无关；PI-RADS 评分和年龄与 PI-RADS 评分的相互作用与高危 PCa 显著相关，但与 csPCa 无关。
在我们的队列中，MRI-超声融合靶向活检在老年男性中高危 PCa 的发生率较高，且与 MRI 结果显著相关，这支持了在活检前进行 MRI 以定位可能导致癌症死亡的疾病的价值，即使在老年男性中也是如此。
