Prostate biopsy strategy integrating prostate health index and multiparametric magnetic resonance imaging optimizes the predictive value of clinically significant prostate cancer in prostate imaging reporting and data system gray-zone imaging

IF 0.8 Q4 UROLOGY & NEPHROLOGY
S. Chiu, Yu-Ching Chen, C. Huang, Yung-Ting Cheng, Y. Pu, Yu-chuan Lu, C. Chiang, Pei-Ling Chen, Jeff Chueh, Jian-Hua Hong
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Abstract

Purpose: The Prostate Health Index (PHI) and multiparametric magnetic resonance imaging (mpMRI) are used as complementary tools for more accurate diagnosis in men with suspected prostate cancer (PCa). This study investigated whether the combination of PHI and mpMRI better predict clinically significant PCa (csPCa), defined as a Gleason score of ≥7. Materials and Methods: Ninety-four men with clinical suspicion of csPCa were prospectively included. PHI was determined before the prostate biopsy. A uroradiologist reviewed mpMRI findings by using the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS version 2.1). Fusion-targeted biopsy with systematic biopsy was performed in patients with any suspicious lesions on MRI (PI-RADS assessment category ≥3), whereas systematic biopsy was performed in patients without suspicious lesions. The diagnostic values of different biomarkers and PI-RADS were compared by the area under the receiver operating curve (area under the curve [AUC]) for detecting csPCa. Results: Forty-nine (52%) patients were diagnosed with csPCa. The csPCa group had higher median PHI and more abnormal MRI findings than did the non-csPCa group. The median total prostate-specific antigen (PSA) level was similar between the PI-RADS 3 and 4 lesion groups. The median PHI values increased and more patients were diagnosed as having csPCa with an increase in PI-RADS. The receiver operating characteristic curve indicated that PHI and MRI (AUC 0.85 and 0.82, respectively) predicted csPCa more accurately than did the total PSA, free PSA ratio, and PSA density. Adding PHI to mpMRI significantly increased the diagnostic accuracy for csPCa (P = 0.004). PHI remained the optimal biomarker in patients with “gray zone” PI-RADS 3 or PI-RADS 4 lesions. Conclusion: PHI can guide decision-making for prostate biopsy for patients with gray-zone mpMRI lesions. We proposed a biopsy strategy incorporating PHI and MRI which resulted in the avoidance of biopsies in 35% of the patients.
结合前列腺健康指数和多参数磁共振成像的前列腺活检策略优化了前列腺影像学报告和数据系统灰区成像对临床显著性前列腺癌的预测价值
目的:前列腺健康指数(PHI)和多参数磁共振成像(mpMRI)作为辅助工具用于更准确的诊断男性前列腺癌(PCa)。本研究探讨了PHI联合mpMRI是否能更好地预测临床显著性PCa (csPCa),定义为Gleason评分≥7。材料与方法:前瞻性纳入临床怀疑患有csPCa的男性94例。前列腺活检前测定PHI。一位泌尿外科医生使用前列腺成像报告和数据系统2.1版本(PI-RADS 2.1版本)对mpMRI结果进行了回顾。MRI上有可疑病变(PI-RADS评估类别≥3)的患者行融合靶向活检加系统活检,无可疑病变的患者行系统活检。通过受试者工作曲线下面积(area under The curve [AUC])对不同生物标志物和PI-RADS检测csPCa的诊断价值进行比较。结果:49例(52%)患者诊断为csPCa。与非csPCa组相比,csPCa组有更高的中位PHI和更多的异常MRI发现。PI-RADS 3和4病变组中位总前列腺特异性抗原(PSA)水平相似。随着PI-RADS的增加,中位PHI值增加,更多的患者被诊断为患有csPCa。受试者工作特征曲线显示,PHI和MRI (AUC分别为0.85和0.82)比总PSA、游离PSA比和PSA密度更准确地预测csPCa。在mpMRI中加入PHI可显著提高csPCa的诊断准确性(P = 0.004)。PHI仍然是PI-RADS 3或PI-RADS 4“灰色地带”病变患者的最佳生物标志物。结论:PHI可指导mpMRI灰色区病变患者前列腺活检的决策。我们提出了一种结合PHI和MRI的活检策略,这导致35%的患者避免了活检。
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来源期刊
Urological Science
Urological Science UROLOGY & NEPHROLOGY-
CiteScore
1.20
自引率
0.00%
发文量
26
审稿时长
6 weeks
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