Orsini Angelo, Ferretti Simone, Porreca Annamaria, Castellan Pietro, Litterio Giulio, Ciavarella Davide, De Palma Antonio, Berardinelli Francesco, Pizzi Andrea D, D'Angelo Emanuela, di Nicola Marta, Schips Luigi, Marchioni Michele
Urology Unit, Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio University', Chieti, Italy.
Department of Medical Oral Science and Biotechnology, G. d'Annunzio University, Chieti, Italy.
Prostate. 2025 Mar;85(4):337-343. doi: 10.1002/pros.24832. Epub 2024 Dec 22.
The introduction of multiparametric prostate magnetic resonance imaging (mpMRI) has revolutionized prostate cancer (PCa) diagnosis, enhancing the localization of clinically significant prostate cancer (csPCa) and guiding targeted biopsies. However, significant disparities in the execution, interpretation, and reporting of prostate MRI examinations across centers necessitate greater standardization and accuracy. This study compares the diagnostic efficacy of mpMRI from academic and nonacademic centers in detecting csPCa and identifies factors associated with csPCa detection.
Between July 2018 and October 2023, we prospectively followed 810 men at SS. Annunziata Hospital of Chieti who underwent MRI/US fusion biopsies due to elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). Patients with mpMRI-documented suspicious lesions classified as PI-RADS ≥ 3 were included. Patients were divided into two groups based on the source of their mpMRI (academic or nonacademic centers). All biopsies were conducted using the MRI/US fusion technique. Clinical, mpMRI, and pathological data were collected and analyzed. Statistical analyses were performed using R software.
The cohort included 354 patients from academic centers and 456 from nonacademic centers. There were no significant differences in patient demographics, such as age and PSA levels, between the groups. Patients at academic centers were more likely to receive a higher number of elevated PI-RADS scores compared to those at nonacademic centers (PI-RADS > 3: 72.6% vs. 62.3%, p = 0.003). Histopathological analysis revealed no significant differences in the ISUP grade distribution between groups. Increased age, PSA levels, and positive DRE were significantly associated with higher odds of detecting csPCa. Median PSA density was significantly higher in patients with csPCa compared to those without csPCa (0.14 vs. 0.11 ng/mL/cm³, p < 0.001). Academic centers exhibited a higher odds ratio for csPCa detection in patients with PI-RADS scores > 3 compared to nonacademic centers.
Our study highlights significant variability in PI-RADS score assignments between academic and nonacademic centers, affecting csPCa detection rates. This variability underscores the need for greater standardization in PI-RADS scoring to reduce disparities and improve diagnostic uniformity across centers.
多参数前列腺磁共振成像（mpMRI）的引入彻底改变了前列腺癌（PCa）的诊断方式，提高了临床显著前列腺癌（csPCa）的定位准确性并指导靶向活检。然而，各中心在前列腺MRI检查的实施、解读和报告方面存在显著差异，因此需要更高的标准化和准确性。本研究比较了学术中心和非学术中心的mpMRI在检测csPCa方面的诊断效能，并确定了与csPCa检测相关 的因素。
2018年7月至2023年10月期间，我们前瞻性地跟踪了基耶蒂圣安农齐亚塔医院的810名男性，这些男性因前列腺特异性抗原（PSA）升高和/或直肠指检（DRE）异常而接受了MRI/超声融合活检。纳入mpMRI记录的可疑病变分类为PI-RADS≥3的患者。根据mpMRI的来源（学术中心或非学术中心）将患者分为两组。所有活检均采用MRI/超声融合技术进行。收集并分析临床、mpMRI和病理数据。使用R软件进行统计分析。
该队列包括来自学术中心的354名患者和来自非学术中心的456名患者。两组患者的人口统计学特征，如年龄和PSA水平，没有显著差异。与非学术中心的患者相比，学术中心的患者获得更高PI-RADS评分的可能性更大（PI-RADS>3：72.6%对62.3%，p=0.003）。组织病理学分析显示，两组之间的ISUP分级分布没有显著差异。年龄增加、PSA水平升高和DRE阳性与检测到csPCa的较高几率显著相关。与没有csPCa的患者相比，csPCa患者的PSA密度中位数显著更高（0.14对0.11 ng/mL/cm³，p<0.001）。与非学术中心相比，学术中心在PI-RADS评分>3的患者中检测csPCa的优势比更高。
我们的研究强调了学术中心和非学术中心在PI-RADS评分分配上存在显著差异，这影响了csPCa的检测率。这种差异凸显了在PI-RADS评分中需要更大的标准化，以减少差异并提高各中心之间的诊断一致性。
