Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer?
Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer?
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DOI：
10.1016/j.juro.2018.08.046
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发表时间：
2019-02-01
影响因子：
6.6
通讯作者：
Abreu, Andre Luis de Castro
中科院分区：
文献类型：
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作者：
Oishi, Masakatsu;Shin, Toshitaka;Abreu, Andre Luis de Castro
目的：我们试图根据多参数磁共振成像和临床特征确定是否有一部分男性可以避免前列腺活检。材料和方法：2011年10月至2017年3月，1149名连续接受前列腺活检的男性中，135名活检前多参数磁共振成像呈阴性，PI-RADS (TM)（前列腺成像报告和数据系统）评分低于3分。根据前列腺特异性抗原密度和既往活检史评估临床显著性前列腺癌的检出率。有临床意义的前列腺癌定义为2级或以上。进行多变量logistic回归分析，以确定活检中非临床显著性前列腺癌的预测因素。结果：前列腺癌检出率为38%，临床显著性前列腺癌检出率为18%。与非临床显著前列腺癌队列相比，活检检测到临床显著前列腺癌的男性前列腺较小（p = 0.004），前列腺特异性抗原密度较高（p = 0.02），既往无活检阴性史（p = 0.01）。前列腺特异性抗原密度小于0.15 ng/ml/cc （p < 0.001）和既往活检阴性（p = 0.005）是活检无临床意义前列腺癌的独立预测因子。多参数磁共振成像对临床意义的前列腺癌活检检测的阴性预测值随着前列腺特异性抗原密度的降低而提高，主要是在既往活检阴性的男性中（p = 0.001），而在初次活检的男性中则没有。32%的男性多参数磁共振成像阴性，前列腺特异性抗原密度小于0.15 ng/ml/cc，既往活检阴性，重复活检无临床意义的前列腺癌。仅多参数磁共振成像阴性、多参数磁共振成像阴性且前列腺特异性抗原密度小于0.15 ng/ml/cc、多参数磁共振成像阴性、前列腺特异性抗原密度小于0.15 ng/ml/cc且既往活检阴性的男性，活检确诊临床显著性前列腺癌的发生率分别为18%、10%和0%。结论：我们建议多参数磁共振成像阴性，前列腺特异性抗原密度小于0.15 ng/ml/cc且既往活检阴性的男性可以安全地避免再次活检。相反，无论多参数磁共振成像是否呈阴性，对于未进行活检的男性，特别是前列腺特异性抗原密度大于0.15 ng/ml/cc的男性，应考虑进行前列腺活检。
Purpose: We sought to determine whether there is a subset of men who can avoid prostate biopsy based on multiparametric magnetic resonance imaging and clinical characteristics.Materials and Methods: Of 1,149 consecutive men who underwent prostate biopsy from October 2011 to March 2017, 135 had prebiopsy negative multiparametric magnetic resonance imaging with PI-RADS (TM) (Prostate Imaging Reporting and Data System) score less than 3. The detection rate of clinically significant prostate cancer was evaluated according to prostate specific antigen density and prior biopsy history. Clinically significant prostate cancer was defined as Grade Group 2 or greater. Multivariable logistic regression analysis was performed to identify predictors of nonclinically significant prostate cancer on biopsy.Results: The prostate cancer and clinically significant prostate cancer detection rates were 38% and 18%, respectively. Men with biopsy detected, clinically significant prostate cancer had a smaller prostate (p = 0.004), higher prostate specific antigen density (p = 0.02) and no history of prior negative biopsy (p = 0.01) compared to the nonclinically significant prostate cancer cohort. Prostate specific antigen density less than 0.15 ng/ml/cc (p < 0.001) and prior negative biopsy (p = 0.005) were independent predictors of absent clinically significant prostate cancer on biopsy. The negative predictive value of multiparametric magnetic resonance imaging for biopsy detection of clinically significant prostate cancer improved with decreasing prostate specific antigen density, primarily in men with prior negative biopsy (p = 0.001) but not in biopsy naive men. Of the men 32% had the combination of negative multiparametric magnetic resonance imaging, prostate specific antigen density less than 0.15 ng/ml/cc and negative prior biopsy, and none had clinically significant prostate cancer on repeat biopsy. The incidence of biopsy identified, clinically significant prostate cancer was 18%, 10% and 0% in men with negative multiparametric magnetic resonance imaging only, men with negative multiparametric magnetic resonance imaging and prostate specific antigen density less than 0.15 ng/ml/cc, and men with negative multiparametric magnetic resonance imaging, prostate specific antigen density less than 0.15 ng/ml/cc and negative prior biopsy, respectively.Conclusions: We propose that a subset of men with negative multiparametric magnetic resonance imaging, prostate specific antigen density less than 0.15 ng/ml/cc and prior negative biopsy may safely avoid rebiopsy. Conversely prostate biopsy should be considered in biopsy naive men regardless of negative multiparametric magnetic resonance imaging, particularly those with prostate specific antigen density greater than 0.15 ng/ml/cc.