Assessing the Clinical Value of Positive Multiparametric Magnetic Resonance Imaging in Young Men with a Suspicion of Prostate Cancer
Assessing the Clinical Value of Positive Multiparametric Magnetic Resonance Imaging in Young Men with a Suspicion of Prostate Cancer
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DOI：
10.1016/j.euo.2019.05.006
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发表时间：
2021-08-06
影响因子：
8.2
通讯作者：
Briganti, Alberto
中科院分区：
文献类型：
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作者：
Stabile, Armando;Dell'Oglio, Paolo;Briganti, Alberto
背景资料：有一个缺乏证据的能力，磁共振成像（MRI）的前列腺检测临床上显着的前列腺癌（csPCa）在年轻patients.Objective：我们假设，MRI的诊断性能csPCa根据患者的年龄而变化。为了解决这个问题，我们评估了不同患者年龄段的MRI靶向活检（MRI-TBx）与系统随机活检（SBx）的csPCa检出率的变化：设计，设置和参与者：我们回顾性地确定了2013年至2018年期间在两个转诊中心接受前列腺MRI和随后活检的930例患者。采用前列腺成像报告和数据系统（PI-RADS）进行MRI报告。干预：MRI检测到PI-RADS评分>= 3的病变在同一会话期间除了SBx外还接受了MRI-TBx。结果测量和统计分析：我们的研究结果分别是年龄与MRI-TBx和SBx的csPCa检测率之间的关系。临床上显著的前列腺癌（PCa）定义为存在Gleason评分>= 3 + 4的PCa。评估了MRI-TBx和SBx的多变量逻辑回归分析（MVA）预测csPCa检测。协变量为年龄、前列腺特异性抗原密度、PI-RADS评分、既往活检状态、直肠指检以及靶向和系统性穿刺次数。MRI检测csPCa的准确性不同的年龄的假设，最后测试与非参数黄土analysis.Results和限制：csPCa的整体率为54%（n = 506）。总体而言，SBx和MRI-TBx时分别有325例（35%）和461例（50%）患者存在csPCa。SBx和MRI-TBx核心的中位数分别为12个（四分位距[IQR]：10-13）和5个（IQR：4-7）。在MVA中，在考虑混杂因素后，活检时的年龄仅是MRI-TBx时csPCa的独立预测因素（比值比：1.05）。在年龄小于50岁的男性中，SBx检测csPCa的概率高于MRI-TBx（40岁时为25% vs 16%）。相反，在年龄>50岁的患者中，MRI-TBx中csPCa的概率高于SBx，在非常年长的患者中达到最高差异（80岁时为48% vs 68%）。主要局限性是回顾性设计和年轻患者数量少。结论：在这项研究中，我们报告了MRI和MRI-TBx在检测csPCa变化方面的性能，根据患者的年龄。患者总结：在年轻患者中，系统随机活检在检测临床意义上的前列腺癌（csPCa）方面的性能相对于磁共振成像靶向活检（MRI-TBx）更高，反映了年轻男性的MRI准确性较低。相反，在老年患者中，与SBx相比，MRI-TBx显示出更高的csPCa检出率的临床获益，表明MRI准确性随着年龄的增加而增加。(C)2019年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: There is a lack of evidence on the ability of magnetic resonance imaging (MRI) of the prostate to detect clinically significant prostate cancer (csPCa) in young patients.Objective: We hypothesised that the diagnostic performance of MRI for csPCa varies according to patient's age. To address this, we assessed the variation in the csPCa detection rate of MRI targeted biopsy (MRI-TBx) versus systematic random biopsy (SBx) across different patient ages.Design, setting, and participants: We retrospectively identified 930 patients who underwent prostate MRI and subsequent biopsy at two referral centres between 2013 and 2018. The Prostate Imaging Reporting and Data System (PI-RADS) was used for MRI reporting.Intervention: A lesion with a PI-RADS score of >= 3 detected at MRI received an MRI-TBx in addition to an SBx during the same session.Outcome measurements and statistical analysis: The outcome of our study was the relationship between age and csPCa detection rate at MRI-TBx and SBx, respectively. Clinically significant prostate cancer (PCa) was defined as the presence of PCa with Gleason score >= 3 + 4. Multivariable logistic regression analyses (MVAs) predicting csPCa detection were assessed for both MRI-TBx and SBx. Covariates were age, prostate-specific antigen density, PI-RADS score, previous biopsy status, digital rectal examination, and the number of targeted and systematic cores. The hypothesis that MRI accuracy in detecting csPCa differed by age was finally tested with a nonparametric loess analysis.Results and limitations: The overall rate of csPCa was 54% (n = 506). Overall, 325 (35%) and 461 (50%) patients had csPCa at SBx and MRI-TBx, respectively. The median numbers of SBx and MRI-TBx cores were 12 (interquartile range [IQR]: 10-13) and 5 (IQR: 4-7), respectively. At MVA, age at biopsy was an independent predictor of csPCa at MRI-TBx only (odds ratio: 1.05), after accounting for confounders. In men aged less than roughly 50 yr, SBx had a higher probability of detecting csPCa relative to MRI-TBx (25% vs 16% at 40 yr). Conversely, in patients aged >50 yr, the probability of csPCa was higher in MRI-TBx than in SBx, reaching the highest difference for very elderly patients (48% vs 68% at 80 yr). The main limitations were the retrospective design and the small number of young patients.Conclusions: In this study, we reported the performance of MRI and MRI-TBx in detecting csPCa changes according to patients' age.Patient summary: In young patients, the performance of a systematic random biopsy in detecting clinically significant prostate cancer (csPCa) is higher relative to magnetic resonance imaging targeted biopsy (MRI-TBx), reflecting the lower accuracy of MRI in younger men. Conversely, in older patients, MRI-TBx showed a clinical benefit with a higher csPCa detection rate compared with SBx, suggesting an increase of MRI accuracy with the increase of age. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.