The comparative effectiveness of mpMRI and MRI-guided biopsy vs regular biopsy in a population-based PSA testing: a modeling study.
The comparative effectiveness of mpMRI and MRI-guided biopsy vs regular biopsy in a population-based PSA testing: a modeling study.
复制标题
DOI：
10.1038/s41598-021-81459-2
复制
发表时间：
2021-01-19
影响因子：
4.6
通讯作者：
de Koning HJ
中科院分区：
文献类型：
--
作者：
Getaneh AM;Heijnsdijk EAM;de Koning HJ
前列腺癌筛查的好处被过度诊断和过度治疗的风险所抵消。在前列腺特异性抗原（PSA）检测阳性后使用多参数磁共振成像（mpMRI）检测，然后进行磁共振成像引导活检（MRIGB）可能会减少这些伤害。本研究的目的是确定mpMRI和MRIGB与常规筛查途径在基于人群的前列腺癌筛查环境中的作用。使用微观模拟模型预测常规PSA筛查（PSA升高的男性，随后进行TRUSGB）和基于MRI的筛查（PSA升高的男性，随后进行mpMRI和MRIGB）的效果。我们预测这两种策略的过度诊断减少、危害-效益比（避免的过度诊断/癌症死亡）、活检数量减少、临床显著癌症检测、避免的前列腺癌死亡、获得的生命年（LYG）和获得的质量调整生命年（QIRES）。进行了单变量敏感性分析和阈值分析，以评估MRI策略中使用的测试敏感性参数的不确定性。与常规途径相比，我们预测MRI途径中过度诊断的风险降低了43%。同样，与常规筛查途径相比，该策略预测的损害-受益比（避免的过度诊断/癌症死亡）较低（分别为1.0 vs 1.8）。与常规筛查途径相比，MRI途径中前列腺癌死亡率降低、LY和QALs增加也略有增加。此外，与常规筛查途径相比，30%的PSA检测阳性的男性可以避免活检。与常规PSA筛查相比，使用mpMRI作为分诊测试，然后使用MRIGB可以大大降低过度诊断的风险，并改善损害-受益平衡，同时最大限度地降低前列腺癌死亡率并获得QOLS。
The benefit of prostate cancer screening is counterbalanced by the risk of overdiagnosis and overtreatment. The use of a multi-parametric magnetic resonance imaging (mpMRI) test after a positive prostate-specific antigen (PSA) test followed by magnetic resonance imaging-guided biopsy (MRIGB) may reduce these harms. The aim of this study was to determine the effects of mpMRI and MRIGB vs the regular screening pathway in a population-based prostate cancer screening setting. A micro-simulation model was used to predict the effects of regular PSA screening (men with elevated PSA followed by TRUSGB) and MRI based screening (men with elevated PSA followed by mpMRI and MRIGB). We predicted reduction of overdiagnosis, harm-benefit ratio (overdiagnosis per cancer death averted), reduction in number of biopsies, detection of clinically significant cancer, prostate cancer death averted, life-years gained (LYG), and quality adjusted life years (QALYs) gained for both strategies. A univariate sensitivity analysis and threshold analysis were performed to assess uncertainty around the test sensitivity parameters used in the MRI strategy.In the MRI pathway, we predicted a 43% reduction in the risk of overdiagnosis, compared to the regular pathway. Similarly a lower harm-benefit ratio (overdiagnosis per cancer death averted) was predicted for this strategy compared to the regular screening pathway (1.0 vs 1.8 respectively). Prostate cancer mortality reduction, LY and QALYs gained were also slightly increased in the MRI pathway than the regular screening pathway. Furthermore, 30% of men with a positive PSA test could avoid a biopsy as compared to the regular screening pathway. Compared to regular PSA screening, the use of mpMRI as a triage test followed by MRIGB can substantially reduce the risk of overdiagnosis and improve the harm-benefit balance, while maximizing prostate cancer mortality reduction and QALYs gained.
登录
查看更多内容
影响因子：
3.8
作者：
Grann, Victor R.;Patel, Priya R.;Jacobson, Judith S.;Warner, Ellen;Heitjan, Daniel F.;Ashby-Thompson, Maxine;Hershman, Dawn L.;Neugut, Alfred I.
通讯作者：
Neugut, Alfred I.
MR/超声融合引导的活检与超声引导活检的比较，以诊断前列腺癌。
DOI：
10.1001/jama.2014.17942
发表时间：
2015-01-27
期刊：
JAMA
影响因子：
--
作者：
Siddiqui MM;Rais-Bahrami S;Turkbey B;George AK;Rothwax J;Shakir N;Okoro C;Raskolnikov D;Parnes HL;Linehan WM;Merino MJ;Simon RM;Choyke PL;Wood BJ;Pinto PA
通讯作者：
Pinto PA
DOI：
10.1056/nejmoa1311593
发表时间：
2014-03-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Bill-Axelson A;Holmberg L;Garmo H;Rider JR;Taari K;Busch C;Nordling S;Häggman M;Andersson SO;Spångberg A;Andrén O;Palmgren J;Steineck G;Adami HO;Johansson JE
通讯作者：
Johansson JE
影响因子：
23.4
作者：
Pokorny, Morgan R.;De Rooij, Maarten;Thompson, Leslie C.
通讯作者：
Thompson, Leslie C.
影响因子：
8.8
作者：
Pashayan, N.;Duffy, S. W.;Neal, D. E.
通讯作者：
Neal, D. E.