基于多参数磁共振成像的 PIRADS-2 病变自然史：来自学术中心的真实数据。

Natural history of PIRADS-2 lesions on serial multiparametric magnetic resonance imaging: Real-life data from an Academic Center.

机构信息

Department of Urology, Koc University, School of Medicine, Istanbul, Türkiye.

Department of Radiology, Koc University, School of Medicine, Istanbul, Türkiye.

出版信息

Urol Oncol. 2025 Jan;43(1):65.e9-65.e15. doi: 10.1016/j.urolonc.2024.08.007. Epub 2024 Sep 10.

DOI:10.1016/j.urolonc.2024.08.007

PMID:39256146

Abstract

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

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。

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。

结论

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。