Choudhary Manish Kumar, Kolanukuduru Kaushik P, Tillu Neeraja, Kotb Ahmed, Dovey Zachary, Buscarini Maurizio, Zaytoun Osama
Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, United States of America.
Department of Urology, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada.
Cent European J Urol. 2024;77(4):592-598. doi: 10.5173/ceju.2024.0157. Epub 2024 Dec 17.
The association between prostate cancer (PCa) lesion volume on multiparametric magnetic resonance imaging (mpMRI) and clinically significant PCa (csPCa) remains a poorly studied aspect of diagnostic workup in patients with suspicion of PCa. The aim of this study was to assess the diagnostic value of mpMRI lesion volume in detecting csPCa.
Patients with an elevated prostate-specific antigen (PSA) and suspicion of PCa underwent mpMRI as part of routine workup. Following this, patients underwent systematic and fusion targeted biopsy of the region of interest (ROI). All target lesions were sampled once in both axial and sagittal planes, with at least 2 cores per target. csPCa was defined as Gleason grade group ≥2, while highly suspicious lesions were considered as those with PI-RADS score ≥4. Multivariate logistic regression was performed for factors predicting csPCa.
Fifty men with a total of 108 mpMRI lesions were included, with a mean age of 71 ±6 years. 52% had prior negative biopsies. The mean lesion volume was 0.95 ±0.04 ml. Thirty-two patients (64%) had positive biopsies, among whom 20 had csPCa. Fifteen patients (30%) had highly suspicious PI-RADS lesions. Multivariate analysis demonstrated that capsular bulging, younger age, small prostate, highly suspicious lesions, high PSA density, and lesion volume >1mL were predictive of csPCa.
Lesion volume on mpMRI may be used as a non-invasive indicator of csPCa. Future studies exploring the correlation between lesion volume and csPCa may enable patients to be monitored by non-invasive means, while ensuring early intervention when needed.
多参数磁共振成像（mpMRI）上前列腺癌（PCa）病变体积与临床显著前列腺癌（csPCa）之间的关联，在疑似PCa患者的诊断检查中仍是一个研究较少的方面。本研究的目的是评估mpMRI病变体积在检测csPCa中的诊断价值。
前列腺特异性抗原（PSA）升高且疑似PCa的患者接受mpMRI检查作为常规检查的一部分。在此之后，患者对感兴趣区域（ROI）进行系统性和融合靶向活检。所有目标病变在轴向和矢状面均采样一次，每个目标至少取2条组织芯。csPCa定义为Gleason分级组≥2，而高度可疑病变被认为是PI-RADS评分≥4的病变。对预测csPCa的因素进行多变量逻辑回归分析。
纳入了50名男性，共有108个mpMRI病变，平均年龄为71±6岁。52%的患者既往活检结果为阴性。平均病变体积为0.95±0.04ml。32名患者（64%）活检结果为阳性，其中20名患有csPCa。15名患者（30%）有高度可疑的PI-RADS病变。多变量分析表明，包膜膨出、年龄较小、前列腺体积小、高度可疑病变、高PSA密度以及病变体积>1mL可预测csPCa。
mpMRI上的病变体积可作为csPCa的非侵入性指标。未来探索病变体积与csPCa之间相关性的研究可能使患者能够通过非侵入性手段进行监测，同时确保在需要时进行早期干预。
