Department of Urology, Koc University, School of Medicine, Istanbul, Türkiye.
Department of Radiology, Koc University, School of Medicine, Istanbul, Türkiye.
Urol Oncol. 2025 Jan;43(1):65.e9-65.e15. doi: 10.1016/j.urolonc.2024.08.007. Epub 2024 Sep 10.
INTRODUCTION/BACKGROUND: The natural history of prostate imaging reporting and data system (PIRADS) score 2 lesions on serial mpMRIs is largely unknown. Herein, we aimed to evaluate the patients with PIRADS-2 index lesions by using serial mpMRI scans to reveal the rates of mpMRI upgrade in PIRADS score and prostate cancer (PCa) detection.
METHODS/MATERIALS: All mpMRI scans with a PIRADS-2 index lesion from our mpMRI database were evaluated retrospectively. Data from 214 biopsy-naïve patients with a PIRADS-2 index lesion on the initial mpMRI who then underwent at least 1 follow-up mpMRI were reevaluated by an experienced uroradiologist and only those (n = 172) who had a PIRADS-2 index lesion on the initial mpMRI according to PIRADS v2.1 were included in the study. mpMRI progression was defined as the detection of any PIRADS ≥3 lesion at follow-up mpMRI. Histopathological results were evaluated in patients undergoing biopsy upon mpMRI progression.
A total of 172 patients with a mean age of 60.1 ± 8.6 years were evaluated. The median PSA at baseline mpMRI was 4.7 (IQR; 3.3-6.7) ng/dl. Overall mpMRI progression was detected in 54 patients (31.4%), 37 were upgraded to PIRADS-3, 16 to PIRADS-4, and one to PIRADS-5. Multivariate logistic regression analysis revealed that a PSA increase of ≥25% during follow-up was the only predictor of mpMRI upgrade (P = 0.019, OR: 2.384). 30 out of 54 patients underwent a prostate biopsy and PCa was detected in 15 patients; 5 with ISUP grade 1, 10 with ISUP grade 2.
Almost half of the patients with a PIRADS-2 index lesion were upgraded to PIRADS ≥3 when evaluated with serial mpMRI when a PSA increase of ≥25% was observed during follow-up. PCa was detected in half of the patients who underwent a biopsy. Serial mpMRI can be recommended when monitoring patients with elevating PSA ≥25%, a prostate biopsy can be considered upon a mpMRI progression.
简介/背景：前列腺影像报告和数据系统（PI-RADS）评分 2 分的病变在连续 mpMRI 上的自然史尚不清楚。在此，我们旨在通过连续 mpMRI 评估具有 PI-RADS-2 指数病变的患者，以揭示 mpMRI 升级为 PI-RADS 评分和前列腺癌（PCa）检出率的比率。
方法/材料：我们的 mpMRI 数据库中所有具有 PI-RADS-2 指数病变的 mpMRI 扫描均进行了回顾性评估。对 214 名初次 mpMRI 上具有 PI-RADS-2 指数病变且至少接受 1 次随访 mpMRI 的活检初治患者的数据进行了重新评估，仅对初始 mpMRI 上具有 PI-RADS-2 指数病变的患者（n=172）根据 PI-RADS v2.1 进行了研究。mpMRI 进展定义为在随访 mpMRI 上检测到任何 PIRADS≥3 病变。在 mpMRI 进展时进行活检的患者评估了组织病理学结果。
共评估了 172 名平均年龄为 60.1±8.6 岁的患者。基线 mpMRI 时 PSA 的中位数为 4.7（IQR；3.3-6.7）ng/dl。共有 54 名患者（31.4%）发现总体 mpMRI 进展，37 例升级为 PI-RADS-3，16 例升级为 PI-RADS-4，1 例升级为 PI-RADS-5。多变量逻辑回归分析显示，随访期间 PSA 增加≥25%是 mpMRI 升级的唯一预测因子（P=0.019，OR：2.384）。54 名患者中有 30 名接受了前列腺活检，其中 15 名患者检出 PCa；5 名患者为 ISUP 分级 1，10 名患者为 ISUP 分级 2。
当观察到随访期间 PSA 增加≥25%时，对具有 PI-RADS-2 指数病变的患者进行连续 mpMRI 评估，其中近一半患者升级为 PI-RADS≥3。在接受活检的患者中，有一半患者检出 PCa。当 PSA 升高≥25%时，可推荐进行连续 mpMRI 监测，当 mpMRI 进展时可考虑进行前列腺活检。
