Straat Konstantius R V, Hagens Marinus J, Cools Paulino Pereira Leonor J, van den Bergh Roderick C N, Mazel Jan Willem, Noordzij M Arjen, Rynja Sybren P
Department of Urology, Spaarne Gasthuis, Hoofddorp, The Netherlands.
Department of Urology, VUmc site, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Eur Urol Open Sci. 2024 Oct 14;70:52-57. doi: 10.1016/j.euros.2024.08.017. eCollection 2024 Dec.
Current guidelines on prostate cancer (PCa) diagnosis recommend risk stratification before prostate biopsy, using either a risk calculator (RC) or magnetic resonance imaging (MRI). The aim of our study was to assess the effectiveness and cost effectiveness of an RC strategy and a direct MRI (dMRI) strategy.
Data for biopsy-naïve men suspected of having PCa on the basis of elevated prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) were retrospectively collected from two large teaching hospitals. The RC and dMRI strategies were evaluated for PCa detection, effectiveness, and costs. The RC strategy used the Rotterdam prostate cancer risk calculator 3/4 and MRI for stratification, while the dMRI strategy directly used MRI findings. Clinically significant (cs)PCa was defined as a Gleason score ≥3 + 4.
In total, 1458 men were included for analysis, of whom 944 were in the RC group and 514 were in the dMRI group. The RC strategy significantly reduced MRI use by 47.8% (52.2% vs 99.8%; < 0.001) and reduced costs by 14.3% (€422.45 vs €492.77; < 0.001) in comparison to the dMRI strategy. The number of patients who underwent prostate biopsy (36.5% vs. 40.9%; = 0.11) and the csPCa detection rate (43.5% vs 45.2%; = 0.69) were similar between the groups. The study is limited by its retrospective nature, so the findings should be interpreted with caution.
Both the RC strategy and the dMRI strategy are viable options for PCa diagnosis, with the former significantly reducing MRI use and overall diagnostic costs per person. Therefore, the RC strategy might be preferred over dMRI, particularly in contexts aiming for sustainable health care practices that optimize resource allocation and cost effectiveness.
We compared two different approaches for men with a suspicion of prostate cancer. One uses a risk calculator to decide on whether to perform an MRI (magnetic resonance imaging) scan, and the other proceeds directly to MRI. In both cases, prostate biopsy is performed in cases with positive MRI findings. The number of patients who needed a biopsy and the cancer detection rate were similar for the two approaches.
当前前列腺癌（PCa）诊断指南建议在前列腺活检前进行风险分层，可使用风险计算器（RC）或磁共振成像（MRI）。我们研究的目的是评估RC策略和直接MRI（dMRI）策略的有效性和成本效益。
回顾性收集了两家大型教学医院中因前列腺特异性抗原（PSA）升高和/或直肠指检（DRE）异常而疑似患有PCa且未进行过活检的男性的数据。对RC和dMRI策略在PCa检测、有效性和成本方面进行了评估。RC策略使用鹿特丹前列腺癌风险计算器3/4并结合MRI进行分层，而dMRI策略直接使用MRI结果。临床显著性（cs）PCa定义为Gleason评分≥3 + 4。
总共纳入1458名男性进行分析，其中944名在RC组，514名在dMRI组。与dMRI策略相比，RC策略显著减少了47.8%的MRI使用（52.2%对99.8%；P < 0.001），并降低了14.3%的成本（422.45欧元对492.77欧元；P < 0.001）。两组之间接受前列腺活检的患者数量（36.5%对40.9%；P = 0.11）和csPCa检测率（43.5%对45.2%；P = 0.69）相似。该研究受其回顾性性质的限制，因此研究结果应谨慎解读。
RC策略和dMRI策略都是PCa诊断的可行选择，前者显著减少了MRI的使用和人均总体诊断成本。因此，RC策略可能比dMRI更受青睐，特别是在旨在优化资源分配和成本效益的可持续医疗实践背景下。
我们比较了两种针对疑似前列腺癌男性的不同方法。一种使用风险计算器来决定是否进行MRI（磁共振成像）扫描，另一种则直接进行MRI检查。在两种情况下，MRI结果为阳性的患者都进行前列腺活检。两种方法中需要活检的患者数量和癌症检测率相似。
