MRI 在前列腺癌 MRI 主动监测中的诊断性与确认性活检作用。
MRI at diagnostic versus confirmatory biopsy during MRI-based active surveillance of prostate cancer.
机构信息
Department of Urology, Loyola University Medical Center, Maywood, IL.
Department of Urology, Loyola University Medical Center, Maywood, IL.
出版信息
Urol Oncol. 2024 Oct;42(10):331.e1-331.e6. doi: 10.1016/j.urolonc.2024.05.021. Epub 2024 Jun 17.
OBJECTIVES
Active surveillance (AS) is a management strategy for patients with favorable risk prostate cancer. Multi-parametric magnetic resonance imaging (mpMRI) may impact upgrading rates, but there is mixed evidence on the appropriate timing to introduce mpMRI. We evaluated timing of initial mpMRI use for patients on AS and compared upgrading and intervention rates for AS candidates who received initial mpMRI before diagnostic biopsy vs. confirmatory biopsy.
SUBJECTS AND METHODS
Patients enrolled in AS captured by the Prospective Loyola Urology mpMRI (PLUM) Prostate Biopsy Cohort which captures men undergoing MRI-fusion prostate biopsy. We included patients enrolled in AS between January 2014 and October 2022. We conducted a retrospective analysis of patients who underwent MRI-fusion prostate biopsy while on AS at our institution. The cohort was stratified by men who underwent first mpMRI prior to diagnostic biopsy (MRI-DBx), confirmatory biopsy (MRI-CBx), or a subsequent surveillance biopsy. Oncologic outcomes including pathologic reclassification, intervention-free survival, progression-free survival, and overall survival were evaluated.
RESULTS
Of 346 patients identified on AS, 94 (27.2%) received mpMRI at the time of diagnostic biopsy, 182 (52.6%) at confirmatory biopsy, and 70 (20.2%) at a later biopsy. At confirmatory biopsy (median 14 months), there was no difference in upgrading (HR 0.95, P = 0.78) or intervention rates (HR 0.97, P = 0.88) between MRI-DBx and MRI-CBx. PI-RADS score on initial mpMRI was associated with upgrading during AS follow-up relative to men with negative mpMRI (HR 4.20 (P = 0.04), 3.24 (P < 0.001), and 1.99 (P < 0.001) for PI-RADS 5, 4, and 3, respectively), and PSA density was associated with intervention (HR 1.52, P = 0.03).
CONCLUSION
mpMRI can serve as a prognostic tool to select and monitor AS patients, but there was no difference in upgrading or intervention rates based on initial timing of MRI.
目的
主动监测（AS）是一种管理低危前列腺癌患者的策略。多参数磁共振成像（mpMRI）可能会影响升级率，但关于引入 mpMRI 的适当时机存在混合证据。我们评估了接受 AS 的患者首次进行 mpMRI 的时间，并比较了在诊断性活检前（mpMRI-DBx）或确认性活检（mpMRI-CBx）接受初始 mpMRI 的 AS 候选者的升级和干预率。
对象和方法
前瞻性洛约拉大学泌尿外科 mpMRI（PLUM）前列腺活检队列纳入了接受 MRI 融合前列腺活检的患者，我们纳入了该队列中自 2014 年 1 月至 2022 年 10 月期间接受 AS 的患者。我们对在我院接受 AS 时进行 MRI 融合前列腺活检的患者进行了回顾性分析。该队列按首次接受 mpMRI 的时间分为接受诊断性活检前（mpMRI-DBx）、确认性活检（mpMRI-CBx）或随后的监测活检前的男性。评估了肿瘤学结果，包括病理再分类、无干预生存、无进展生存和总生存。
结果
在确定的 346 名 AS 患者中，94 名（27.2%）在诊断性活检时接受了 mpMRI，182 名（52.6%）在确认性活检时接受了 mpMRI，70 名（20.2%）在后续活检时接受了 mpMRI。在确认性活检（中位时间 14 个月）时，mpMRI-DBx 和 mpMRI-CBx 之间升级率（HR 0.95，P=0.78）和干预率（HR 0.97，P=0.88）无差异。与 mpMRI 阴性的男性相比，在 AS 随访期间，初始 mpMRI 的 PI-RADS 评分与升级相关（HR 4.20（P=0.04）、3.24（P<0.001）和 1.99（P<0.001），分别为 PI-RADS 5、4 和 3），而 PSA 密度与干预相关（HR 1.52，P=0.03）。
结论
mpMRI 可作为选择和监测 AS 患者的预后工具，但基于 MRI 的初始时机，升级或干预率无差异。
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