评估黑人和亚洲男性的PI-RADS病变及临床显著前列腺癌：一项PREVENT随机临床试验的二次分析

Evaluating PI-RADS lesions and clinically significant prostate cancer in Black and Asian men: a PREVENT randomized clinical trial secondary analysis.

作者信息

Driscoll Conor, Handa Nicole, Huang Mitchell, Murphy Adam, Hu Jim, Schaeffer Edward

机构信息

Northwestern University Feinberg School of Medicine.

Northwestern University, Feinberg School of Medicine.

出版信息

Res Sq. 2025 Jul 4:rs.3.rs-6905600. doi: 10.21203/rs.3.rs-6905600/v1.

PURPOSE

Non-White patients are poorly represented in prostate cancer trials. MRI PI-RADS scoring was developed in primarily White populations, but prostate cancer differs in non-White men. We aimed to explore differences in PI-RADS calibration for Asian and Black men.

MATERIALS AND METHODS

This is a secondary analysis of PREVENT, a multi-institutional study of infection rates for transrectal vs. transperineal biopsy. We compared cancer detection for self-identifying Asian and Black men. We compared detection rates on a per-person basis, stratified by index PI-RADS lesion, to White men, using Fisher's exact and logistic regression.

RESULTS

Of 665/752 trial patients with PI-RADS 3-5 lesions, 88 (13%) were Black and 36 (6%) were Asian. Black men were younger at diagnosis with increased rates of overall (70% vs. 43%%, =0.004) and clinically significant prostate cancer (60% vs. 27%, =0.003) and Asian men had decreased rates of overall (0% vs. 47%, =0.004) and clinically significant prostate cancer (0% vs. 27%, =0.003) in PI-RADS 3 lesions compared to White men. On multivariable regression, Black men with PI-RADS 3/4 lesions had higher odds of overall (OR 1.17, =0.009) and clinically significant prostate cancer (OR 1.20, =0.004) and Asian men had lower odds of overall (OR 0.79, =0.01) but not clinically significant prostate cancer (OR 0.94, =0.5).

CONCLUSIONS

Black men with PI-RADS 3/4 lesions had 20% higher odds of clinically significant prostate cancer than White men while all PI-RADS 3 lesions in Asian men were negative. These findings suggest PI-RADS may require differential interpretation when assessing prostate cancer risk in non-White men.

SOURCE OF FUNDING

Supported by the NCI (5R01CA241758-05).

TRIAL REGISTRATION

Registered at ClinicalTrials.gov (NCT04843566, https://clinicaltrials.gov/study/NCT04843566).

目的

在前列腺癌试验中，非白人患者的代表性不足。MRI前列腺影像报告和数据系统（PI-RADS）评分主要是在白人人群中开发的，但前列腺癌在非白人男性中有所不同。我们旨在探讨亚洲和黑人男性在PI-RADS校准方面的差异。

材料与方法

这是对PREVENT的二次分析，PREVENT是一项关于经直肠与经会阴活检感染率的多机构研究。我们比较了自我认定为亚洲和黑人男性的癌症检测情况。我们使用Fisher精确检验和逻辑回归，按索引PI-RADS病变分层，以白人男性为对照，比较了每人的检测率。

结果

在665/752例有PI-RADS 3-5级病变的试验患者中，88例（13%）为黑人，36例（6%）为亚洲人。与白人男性相比，黑人男性诊断时年龄更小，总体前列腺癌（70%对43%，P=0.004）和临床意义重大的前列腺癌发生率更高（60%对27%，P=0.003）；在PI-RADS 3级病变中，亚洲男性总体前列腺癌（0%对47%，P=0.004）和临床意义重大的前列腺癌发生率更低（0%对27%，P=0.003）。在多变量回归分析中，有PI-RADS 3/4级病变的黑人男性总体前列腺癌（比值比1.17，P=0.009）和临床意义重大的前列腺癌发生几率更高（比值比1.20，P=0.004），亚洲男性总体前列腺癌发生几率更低（比值比0.79，P=0.01），但临床意义重大的前列腺癌发生几率无差异（比值比0.94，P=0.5）。

结论

有PI-RADS 3/4级病变的黑人男性临床意义重大的前列腺癌发生几率比白人男性高20%，而亚洲男性所有PI-RADS 3级病变均为阴性。这些发现表明，在评估非白人男性前列腺癌风险时，PI-RADS可能需要进行差异解读。

资金来源

由美国国立癌症研究所资助（5R01CA241758-05）。

试验注册

在ClinicalTrials.gov注册（NCT04843566，https://clinicaltrials.gov/study/NCT04843566）