Kemesiene Jurate, Nicolau Carlos, Cholstauskas Gytis, Zviniene Kristina, Lopeta Mantvydas, Veneviciute Simona, Asmenaviciute Ieva, Tamosauskaite Kamile, Pikuniene Ingrida, Jievaltas Mindaugas
Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Mickeviciaus str. 9, Kaunas, 44307, Lithuania.
Department of Radiology, Hospital Clínic, University of Barcelona, Barcelona, 08036, Spain.
Abdom Radiol (NY). 2025 Jan 25. doi: 10.1007/s00261-024-04727-5.
This study aimed to investigate the accuracy of multiparametric magnetic resonance imaging (mpMRI), genetic urinary test (GUT), and prostate cancer prevention trial risk calculator version 2.0 (PCPTRC2) for the clinically significant prostate cancer (csPCa) diagnostic in biopsy-naïve patients.
In a single center study between 2021 and 2024 participants underwent prostate mpMRI, GUT, and ultrasound (US) guided biopsy. The csPCa risk was calculated using PCPTRC2. After conducting a digital rectal examination (DRE), a GUT was performed. It incorporated the RNA levels of prostate cancer antigen 3 (PCA3) and transmembrane serine protease 2 (TMPRSS2) gene and ETS-related gene (ERG) fusion genes (T: E), along with the patient's age and PSA density. The McNemar test compared detection rates between modalities.
208 (mean age 62.9 years +/- 8.2) men were included prospectively. A positive GUT score was found in 67.8% and PIRADS ≥3 in 81.7% of all cases. The combination of GUT with mpMRI showed significantly higher sensitivity (99.1%) than GUT and mpMRI alone, 84.4% and 93.8%, respectively (p ≤ 0.05). Similarly, very high sensitivity (99.0%) was achieved by combining mpMRI with PCPTCR2. Nevertheless, mpMRI plus GUT combination exceeded mpMRI plus PCPTCR2 by allowing to save a higher fraction of unnecessary biopsies, 25% and 2.4%, respectively.
GUT and mpMRI combination would allow saving a substantial fraction of unnecessary biopsies with minimal risk of missing csPCa cases.
本研究旨在探讨多参数磁共振成像（mpMRI）、基因尿液检测（GUT）和前列腺癌预防试验风险计算器2.0版（PCPTRC2）在未进行活检的患者中对临床显著前列腺癌（csPCa）诊断的准确性。
在一项2021年至2024年的单中心研究中，参与者接受了前列腺mpMRI、GUT和超声（US）引导下的活检。使用PCPTRC2计算csPCa风险。在进行直肠指检（DRE）后，进行GUT检测。它纳入了前列腺癌抗原3（PCA3）、跨膜丝氨酸蛋白酶2（TMPRSS2）基因和ETS相关基因（ERG）融合基因（T:E）的RNA水平，以及患者的年龄和PSA密度。采用McNemar检验比较不同检测方式之间的检出率。
前瞻性纳入了208名男性（平均年龄62.9岁±8.2岁）。所有病例中，67.8%的患者GUT评分呈阳性，81.7%的患者前列腺影像报告和数据系统（PIRADS）≥3。GUT与mpMRI联合使用时的敏感性（99.1%）显著高于单独使用GUT和mpMRI时，单独使用GUT和mpMRI时的敏感性分别为84.4%和93.8%（p≤0.05）。同样，mpMRI与PCPTCR2联合使用时也具有非常高的敏感性（99.0%）。然而，mpMRI加GUT联合使用比mpMRI加PCPTCR2能减少更多不必要的活检，分别为25%和2.4%。
GUT与mpMRI联合使用能够减少大量不必要的活检，同时遗漏csPCa病例的风险最小。
