Department of Urology, Hospital Universitario Sanitas La Moraleja, Avenida de Francisco Pi y Margall, 81, 28050, Madrid, Spain; Universidad Francisco de Vitoria, Carretera Pozuelo a, Av de Majadahonda, Km 1.800, 28223, Madrid, Spain.
Department of Urology, Hospital Universitario Sanitas La Moraleja, Avenida de Francisco Pi y Margall, 81, 28050, Madrid, Spain; Universidad Francisco de Vitoria, Carretera Pozuelo a, Av de Majadahonda, Km 1.800, 28223, Madrid, Spain.
Clin Genitourin Cancer. 2024 Oct;22(5):102130. doi: 10.1016/j.clgc.2024.102130. Epub 2024 May 31.
Granulomatous prostatitis is a medical condition that may mimic prostate cancer.
Granulomatous prostatitis resulting from BCG-exposure can confound the diagnosis of prostate cancer based on prostate imaging and data system (PI-RADS) classification observed on multiparametric prostate magnetic resonance imaging (mpMRI).
STUDY TYPE, POPULATION, ASSESSMENT AND STATISTICAL TESTS: A cohort study was conducted, enrolling consecutive males at risk for prostate cancer who underwent an mpMRI-targeted prostate biopsy between February 2016 and August 2023. The focus of the study was on prior BCG-exposure as adjuvant treatment for non-muscle-invasive urothelial carcinoma within the 3 years prior the magnetic resonance imaging (MRI). Exclusion criteria were a prior androgen deprivation therapy, prostate surgery or radiation, and BCG-exposure occurring more than 3 years and less than 3 months before the MRI. Chi-square, logistic-regression, statistical association, and homogeneity tests were used.
Total 712 patients, 899 biopsied lesions (218 PI-RADS 3, 521 PI-RADS 4 and 160 PI-RADS 5) and 20 patients with 30 lesions within the BCG-exposed cohort. Chi-square and logistic-regression tests showed an association between PI-RADS with malignancy and significant tumor (ST), considering PI-RADS3 as the reference (OR: 4.9 [95% CI, 3.4-7.1] for PI-RADS4 and OR: 21.7 [95% CI, 12.4-37.8] for PI-RADS5 for malignancy, and OR: 5.3 [95% CI, 3.2-8.7] for PI-RADS4 and OR: 16.5 [95% CI, 9.4-28.9] for PI-RADS5 regarding ST). A statistically significant negative association was demonstrated between malignancy and ST with respect to BCG-exposure (OR: 0.15 [95% CI, 0.06-0.39] and OR: 0.39 [95% CI, 0.15-1.0], respectively). Statistically significant risk-difference for malignancy in patients nonexposed to BCG regarding those exposed was 45% (61.6% vs. 16.7%) for PI-RADS4, and 68.5% (90.7% vs. 22.2%) and 42.7% (64.9% vs. 22.2%) concerning malignancy and ST for PI-RADS5, respectively.
Granulomatous prostate reaction caused by BCG-exposure acts as confounding factor for prostate MRI interpretation. The risk of malignancy and significant tumor on targeted biopsy to PI-RADS 3, 4 and 5 is notably lower in exposed patients.
肉芽肿性前列腺炎是一种可能模仿前列腺癌的医学病症。
BCG 暴露引起的肉芽肿性前列腺炎可能会混淆基于前列腺成像和数据系统（PI-RADS）分类的前列腺癌诊断，这种分类可在多参数前列腺磁共振成像（mpMRI）上观察到。
研究类型、人群、评估和统计检验：进行了一项队列研究，纳入了 2016 年 2 月至 2023 年 8 月期间因患有非肌肉浸润性尿路上皮癌而接受 mpMRI 靶向前列腺活检的风险男性连续患者。研究的重点是在 MRI 前 3 年内接受卡介苗（BCG）作为辅助治疗的既往 BCG 暴露。排除标准是既往雄激素剥夺治疗、前列腺手术或放疗，以及 BCG 暴露发生在 MRI 前 3 年以上且 3 个月以内。使用卡方检验、逻辑回归、统计关联和同质性检验。
共有 712 名患者，899 个活检病变（218 个 PI-RADS 3、521 个 PI-RADS 4 和 160 个 PI-RADS 5）和 20 名患者的 30 个病变在 BCG 暴露组中。卡方检验和逻辑回归检验显示，PI-RADS 与恶性肿瘤和显著肿瘤（ST）之间存在关联，将 PI-RADS3 作为参考（OR：4.9[95%CI，3.4-7.1]PI-RADS4 和 OR：21.7[95%CI，12.4-37.8]PI-RADS5 为恶性肿瘤，OR：5.3[95%CI，3.2-8.7]PI-RADS4 和 OR：16.5[95%CI，9.4-28.9]PI-RADS5 为 ST）。结果表明，BCG 暴露与恶性肿瘤和 ST 之间存在统计学显著的负相关（OR：0.15[95%CI，0.06-0.39]和 OR：0.39[95%CI，0.15-1.0]）。未暴露于 BCG 的患者与暴露于 BCG 的患者相比，PI-RADS4 的恶性肿瘤风险差异有统计学意义（61.6% vs. 16.7%），PI-RADS5 的恶性肿瘤和 ST 风险差异有统计学意义（90.7% vs. 22.2%和 42.7% vs. 22.2%）。
BCG 暴露引起的肉芽肿性前列腺反应是前列腺 MRI 解释的混杂因素。暴露患者的靶向活检至 PI-RADS 3、4 和 5 的恶性肿瘤和显著肿瘤的风险明显较低。
