Jin Pengfei, Wang Ximing, Ding Zhenwei, Yang Liqin, Xu Chenyang, Wang Xu, Huang Fawei
Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China.
Ann Med. 2025 Dec;57(1):2446695. doi: 10.1080/07853890.2024.2446695. Epub 2025 Jan 1.
Develop risk-adapted conditional biopsy pathways utilizing MRI in combination with prostate-specific antigen (PSA) density (PSAD) and the ratio of free to total PSA (f/tPSA), respectively, to enhance the detection of clinically significant prostate cancer (csPCa) while minimizing 'negative' biopsies in low-risk patients.
The Prostate Imaging Reporting and Data System (PI-RADS) category, PSAD, f/tPSA and biopsy-pathology of 1018 patients were collected retrospectively. Subsequently, PSAD and f/tPSA were divided into four intervals, which were then combined with the MRI findings to construct two risk stratification matrix tables. Six biopsy decision pathways were established: three clinical pathways based solely on PSAD and f/tPSA, and three MRI-combined pathways incorporating both PI-RADS and PSA-derived indicators. The biopsy and clinically insignificant PCa (ciPCa) avoidance, csPCa detection rate, and 'negative' biopsies proportion were assessed. Decision curve analysis (DCA) was employed to evaluate the net benefit associated with each pathway.
When reporting PI-RADS 1 - 2, PSAD ≥ 0.20 ng/ml/cm or f/tPSA ≤ 0.10 were found to be useful for patient stratification. When reporting PI-RADS 3, PSAD ≥ 0.10 - 0.15 ng/ml/cm and f/tPSA ≤ 0.16 - 0.25 were helpful in distinguishing the risk of csPCa. The three MRI-combined pathways showed higher csPCa detection rates (94% to 96%) than the three clinical pathways (85% to 91%); 'MRI + PSAD + f/tPSA' demonstrated a high csPCa detection rate of 94% while maintaining the maximum biopsy avoidance and lowest 'negative' biopsy proportion of 40% and 25%, respectively. The DCA showed significantly higher net benefits for three MRI-combined pathways compared to all clinical pathways.
The integration of MRI and PSA-derived indicators enables effective patient risk stratification, thereby providing valuable decision-making pathways to enhance the management of csPCa while minimizing 'negative' biopsies.
分别利用磁共振成像（MRI）结合前列腺特异性抗原（PSA）密度（PSAD）以及游离PSA与总PSA的比值（f/tPSA），制定风险适应性条件活检路径，以提高临床显著性前列腺癌（csPCa）的检测率，同时将低风险患者的“阴性”活检降至最低。
回顾性收集1018例患者的前列腺影像报告和数据系统（PI-RADS）类别、PSAD、f/tPSA及活检病理结果。随后，将PSAD和f/tPSA分为四个区间，再与MRI结果相结合，构建两个风险分层矩阵表。建立了六种活检决策路径：三种仅基于PSAD和f/tPSA的临床路径，以及三种结合PI-RADS和PSA衍生指标的MRI联合路径。评估活检及避免临床意义不显著的前列腺癌（ciPCa）情况、csPCa检测率及“阴性”活检比例。采用决策曲线分析（DCA）评估各路径的净效益。
报告PI-RADS 1 - 2时，发现PSAD≥0.20 ng/ml/cm或f/tPSA≤0.10有助于患者分层。报告PI-RADS 3时，PSAD≥0.10 - 0.15 ng/ml/cm且f/tPSA≤0.16 - 0.25有助于区分csPCa风险。三种MRI联合路径的csPCa检测率（94%至96%）高于三种临床路径（85%至91%）；“MRI + PSAD + f/tPSA”的csPCa检测率高达94%，同时分别保持最高的活检避免率和最低的“阴性”活检比例，分别为40%和25%。DCA显示，与所有临床路径相比，三种MRI联合路径的净效益显著更高。
MRI与PSA衍生指标的整合能够实现有效的患者风险分层，从而提供有价值的决策路径，以加强csPCa的管理，同时将“阴性”活检降至最低。
