Department of Urology, Yale School of Medicine, New Haven, Connecticut.
Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut.
Urol Pract. 2024 Nov;11(6):965-973. doi: 10.1097/UPJ.0000000000000679. Epub 2024 Jul 16.
Although prostate MRI and tissue-based gene expression (genomic) tests improve staging and estimates of prostate cancer prognosis, their association with the intensity of treatment patients receive is not well understood.
We performed a retrospective cohort study of Medicare beneficiaries diagnosed with clinically localized prostate cancer in 2013 through 2017 in the Surveillance, Epidemiology, and End Results database. The primary study outcome was the receipt of treatment intensification in the first 12 months after diagnosis (defined as the addition of androgen deprivation therapy among patients receiving radiation or pelvic lymphadenectomy among those undergoing radical prostatectomy). We assessed associations between the receipt of prostate MRI and genomic testing and treatment intensification, adjusting for clinical and sociodemographic factors and further stratifying the analyses by risk status.
We identified 37,064 patients with clinically localized prostate cancer, including 6398, 22,011, and 5976 with low, intermediate, and high D'Amico-risk disease, respectively. Among all treated patients, receipt of prostate MRI was associated with increased odds of treatment intensification (odds ratio 1.76, 95% CI 1.65-1.88, < .001). In contrast, genomic testing was not significantly associated. Among treated patients with high-risk disease, genomic testing was associated with decreased odds of intensified treatment (odds ratio 0.59, 95% CI 0.35-1.00, = .05).
Prostate MRI was associated with intensified treatment across risk strata, while genomic testing was associated with lower intensity of treatment among high-risk disease. Additional study is needed to determine whether use of imaging and risk stratification tools leads to improved long-term patient outcomes.
尽管前列腺磁共振成像（MRI）和基于组织的基因表达（基因组）检测可改善分期和前列腺癌预后的评估，但人们对其与患者接受治疗强度的关联了解甚少。
我们对 2013 年至 2017 年期间，在监测、流行病学和最终结果数据库中诊断为局限性前列腺癌的 Medicare 受益人群进行了回顾性队列研究。主要研究结果是在诊断后的 12 个月内接受治疗强化（定义为接受放疗的患者中添加雄激素剥夺治疗，或接受根治性前列腺切除术的患者中添加盆腔淋巴结清扫术）。我们评估了前列腺 MRI 和基因组检测与治疗强化之间的关系，同时调整了临床和社会人口统计学因素，并根据风险状况进一步分层分析。
我们确定了 37064 例局限性前列腺癌患者，其中低危、中危和高危 D'Amico 疾病患者分别为 6398、22011 和 5976 例。在所有接受治疗的患者中，接受前列腺 MRI 与治疗强化的几率增加相关（比值比 1.76，95%置信区间 1.65-1.88，<0.001）。相比之下，基因组检测与治疗强化无显著相关性。在高危疾病的治疗患者中，基因组检测与强化治疗的几率降低相关（比值比 0.59，95%置信区间 0.35-1.00，=0.05）。
前列腺 MRI 与各风险分层的强化治疗相关，而基因组检测与高危疾病的治疗强度降低相关。需要进一步研究，以确定影像学和风险分层工具的使用是否可改善长期患者结局。
