Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer.
Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer.
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前列腺健康指数和多参数MRI：与前列腺癌过度诊断和过度治疗的犯罪伙伴。
DOI：
10.3390/cancers13184723
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发表时间：
2021-09-21
期刊：
影响因子：
5.2
通讯作者：
Terracciano D
中科院分区：
文献类型：
--
作者：
Ferro M;Crocetto F;Bruzzese D;Imbriaco M;Fusco F;Longo N;Napolitano L;La Civita E;Cennamo M;Liotti A;Lecce M;Russo G;Insabato L;Imbimbo C;Terracciano D
在过去的几十年里，PSA作为前列腺癌诊断的标准工具的广泛使用导致了过度诊断和过度治疗的高发生率。最近，多参数磁共振成像（mpMRI）成为诊断途径的一部分，并提出了几种基于PSA的下一代测试（PHI，PHI密度，4Kscore，STHLM 3）。多变量方法有望帮助PCa患者在初次诊断时更好地分层。在这项研究中，我们评估了前列腺健康指数（PHI）和mpMRI在根治性前列腺切除术（RP）中预测阳性活检和高级别PCa的性能。我们的研究结果表明，PHI有更好的能力比mpMRI预测阳性活检，而在识别病理性侵袭性PCa的性能相当指出。值得注意的是，PHI和PHI密度可能代表有用的生物标志物，用于识别mpMRI上PI-RADS评分较低或不确定的患者中的高级别PCa。广泛使用PSA作为前列腺癌（PCa）诊断的标准工具，导致过度诊断和过度治疗的发生率很高。在这项研究中，我们评估了前列腺健康指数（PHI）和多参数磁共振成像（mpMRI）在预测根治性前列腺切除术（RP）中活检阳性和高级别PCa的性能。为此，我们前瞻性入组了196例接受mpMRI的活检初治患者。一个由116名活检证实的PCa受试者组成的亚组接受了手术。我们发现，在预测阳性活检的能力方面，PHI显著优于PI-RADS评分（AUC差异：0.14; p < 0.001）和PHI密度（AUC差异：0.08; p = 0.002），截止值为42.7作为最佳阈值。相反，比较RP时识别具有临床意义的前列腺癌（csPCa）的性能，我们发现PHI ≥ 61.68和PI-RADS评分≥ 4能够单独识别csPCa（Gleason评分≥ 7（3 + 4）），并添加到包括年龄、PSA、fPSA/tPSA比值和前列腺体积的基础模型中。总之，PHI比PI-RADS评分更能预测阳性活检，而在鉴别病理性csPCa方面具有相当的性能。
In the last decades, the widespread use of PSA as the standard tool for prostate cancer diagnosis led to a high rate of overdiagnosis and overtreatment. More recently, multiparametric magnetic resonance imaging (mpMRI) became part of the diagnostic pathway, and several next-generation PSA-based tests (PHI, PHI density, 4Kscore, STHLM3) have been proposed. The multivariable approach promises to help with a better stratification of PCa patients at initial diagnosis. In this study, we evaluated the performance of the prostate health index (PHI) and mpMRI for the prediction of positive biopsy and of high-grade PCa at radical prostatectomy (RP). Our findings suggested that PHI had a better ability than mpMRI to predict positive biopsy, whereas a comparable performance in the identification of pathological aggressive PCa was pointed out. Notably, PHI and PHI density might represent useful biomarkers to recognize high-grade PCa in patients with low or uncertain PI-RADS scores on mpMRI. Widespread use of PSA as the standard tool for prostate cancer (PCa) diagnosis led to a high rate of overdiagnosis and overtreatment. In this study, we evaluated the performance of the prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the prediction of positive biopsy and of high-grade PCa at radical prostatectomy (RP). To this end, we prospectively enrolled 196 biopsy-naïve patients who underwent mpMRI. A subgroup of 116 subjects with biopsy-proven PCa underwent surgery. We found that PHI significantly outperformed both PI-RADS score (difference in AUC: 0.14; p < 0.001) and PHI density (difference in AUC: 0.08; p = 0.002) in the ability to predict positive biopsy with a cut-off value of 42.7 as the best threshold. Conversely, comparing the performance in the identification of clinically significant prostate cancer (csPCa) at RP, we found that PHI ≥ 61.68 and PI-RADS score ≥ 4 were able to identify csPCa (Gleason score ≥ 7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. In conclusion, PHI had a better ability than PI-RADS score to predict positive biopsy, whereas it had a comparable performance in the identification of pathological csPCa.
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