Sharma Deepak, Mitra Devpriya, Bansal Vikas K, Singh Kunwar V
Urology, Shalby Sanar International Hospital, Gurgaon, IND.
Urology, Marengo Asia Hospital, Faridabad, IND.
Cureus. 2025 Jun 17;17(6):e86216. doi: 10.7759/cureus.86216. eCollection 2025 Jun.
Background Prostate cancer requires early and accurate diagnosis to improve outcomes of various treatment modalities. Multi-parametric MRI (MP-MRI) has emerged as a non-invasive imaging modality for detecting and evaluating prostate cancer for histological diagnosis; however, transrectal ultrasound (TRUS)-guided biopsy is still the gold standard. Aim To study the correlation between MP-MRI prostate findings using Prostate Imaging Reporting and Data System (PIRADS) scoring and TRUS-guided prostate biopsy results, including Gleason's score, in patients with raised serum PSA. Materials and methods The present prospective research comprises 66 patients aged 40-80 years with PSA >4 ng/ml or free-to-total PSA ratio <0.15, who attended the urology department at Pushpawati Singhania Research Institute, New Delhi, between May 2018 and March 2020. MP-MRI was performed on all patients, along with cognitive MP-MRI-targeted biopsy and systematic 12-core TRUS-guided biopsy. Gleason's scoring and immunohistochemistry (IHC) were used to confirm malignancy. Results MP-MRI revealed that 71.21% of patients had probably malignant or malignant findings (PIRADS 4/5). TRUS biopsy confirmed malignancy in 72.7% of patients. Gleason's score and the PIRADS score showed a strong connection (p <0.05). MP-MRI showed a 72.22% specificity, 87.5% sensitivity, 68.42% negative predictive value (NPV), 89.36% positive predictive value (PPV), and 83.33% diagnostic accuracy for detecting prostate cancer. Cognitive MP-MRI-targeted biopsy detected cancer in 66.67% of patients, while systematic biopsy detected it in 56%. The combination of both methods yielded the highest diagnostic accuracy. Inter-rater kappa agreement between MP-MRI and the TRUS biopsy was moderately strong (κ = 0.587, p<0.001). Conclusion MP-MRI has been a highly sensitive and specific modality in identifying clinically significant prostate cancer. PI-RADS scoring offers a standardized and reproducible method for evaluating prostate lesions. A cognitive MP-MRI-targeted TRUS biopsy, especially in conjunction with systematic biopsy, significantly improves prostate cancer detection rates, especially in PIRADS 4 or higher cases.
背景 前列腺癌需要早期准确诊断以改善各种治疗方式的效果。多参数磁共振成像（MP-MRI）已成为一种用于检测和评估前列腺癌以进行组织学诊断的非侵入性成像方式；然而，经直肠超声（TRUS）引导下的活检仍是金标准。目的 研究使用前列腺影像报告和数据系统（PIRADS）评分的MP-MRI前列腺检查结果与TRUS引导下前列腺活检结果（包括 Gleason 评分）之间的相关性，研究对象为血清 PSA 升高的患者。材料与方法 本前瞻性研究纳入了66例年龄在40 - 80岁之间、PSA>4 ng/ml或游离PSA与总PSA比值<0.15的患者，这些患者于2018年5月至2020年3月期间就诊于新德里普什帕瓦蒂·辛哈尼亚研究所泌尿外科。对所有患者进行了MP-MRI检查，同时进行了认知性MP-MRI靶向活检和系统性12针TRUS引导下活检。采用Gleason评分和免疫组织化学（IHC）来确诊恶性肿瘤。结果 MP-MRI显示71.21%的患者有可能为恶性或恶性的检查结果（PIRADS 4/5）。TRUS活检确诊72.7%的患者为恶性。Gleason评分与PIRADS评分显示出强相关性（p<0.05）。MP-MRI检测前列腺癌的特异性为72.22%，敏感性为87.5%，阴性预测值（NPV）为68.42%，阳性预测值（PPV）为89.36%，诊断准确性为83.33%。认知性MP-MRI靶向活检在66.67%的患者中检测到癌症，而系统性活检在56%的患者中检测到癌症。两种方法联合使用产生了最高的诊断准确性。MP-MRI与TRUS活检之间的评分者间kappa一致性为中等强度（κ = 0.587，p<0.001）。结论 MP-MRI在识别具有临床意义的前列腺癌方面一直是一种高度敏感和特异的检查方式。PI-RADS评分提供了一种标准化且可重复的方法来评估前列腺病变。认知性MP-MRI靶向TRUS活检，尤其是与系统性活检联合使用时，可显著提高前列腺癌的检测率，特别是在PIRADS 4或更高的病例中。
