PSA密度选择MRI靶向与联合活检诊断前列腺癌:三重奏研究的二次分析。

IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Journal of Urology Pub Date : 2025-06-01 Epub Date: 2025-02-14 DOI:10.1097/JU.0000000000004480
Michael Ahdoot, Aurash Naser-Tavakolian, John R Heard, Cheyenne Williams, Michael Daneshvar, Patrick Gomella, Samhita Mallavarapu, Minhaj Siddiqui, Michael Nazmifar, Joanna Shih, Baris Turkbey, Bradford Wood, Peter Pinto
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引用次数: 0

摘要

目的:与单独进行mri靶向活检相比,系统前列腺活检的增加提高了对临床显著前列腺癌的检测。然而,越来越多的人对仅使用mri靶向活检感兴趣。我们试图评估PSA密度作为在接受联合活检的男性中诊断出具有临床意义的前列腺癌的辅助预测因子,并作为一种潜在的指标来分层哪些患者可以合理地避免系统活检,而只支持mri靶向活检。材料和方法:PSA升高和/或直肠指检异常的男性发现mri可见的前列腺病变,进行mri靶向和系统的前列腺活检。主要结果是mri靶向、系统活检和四个离散PSA密度间隔(>0.1、>0.15和>0.2 ng/ml/cm3)的联合活检的临床显著癌症检出率。次要结果是系统活检相对于单独mri靶向活检的附加价值。结果:在PI-RADS >2病变男性中,随着PSA密度超过每个区间,>3级组癌检出率约翻倍(>0.1、>0.15、>0.2:61.2%)。当PSA密度为>.2时,系统活检对临床显著癌的附加检出率较低(2%,95%CI:0.4%-5.9%)。结论:考虑到联合活检中bbbb3级组的癌症检出率大约翻倍,且PSA密度间隔增加,临床医生可以考虑将PSA密度划分为具有临床意义的前列腺癌高风险男性。对于PSA密度为>0.2ng/ml/cm3的患者,临床医生可能会考虑忽略系统活检,对mri可见病变进行靶向活检,因为系统活检导致额外的具有临床意义的癌症检测率较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prostate-Specific Antigen Density to Select Magnetic Resonance Imaging-Targeted vs Combined Biopsy for Prostate Cancer Diagnosis: A Secondary Analysis of the Trio Study.

Purpose: The addition of systematic prostate biopsy enhances the detection of clinically significant prostate cancer compared with MRI-targeted biopsy alone. However, there is growing interest in using only MRI-targeted biopsy. We sought to evaluate PSA density (PSAD) as an adjunctive predictor of clinically significant prostate cancer detection in men undergoing combined biopsy and as a potential metric to stratify which patients may reasonably avoid systematic biopsies in favor of MRI-targeted biopsy only.

Materials and methods: Men with elevated PSA and/or abnormal digital rectal examination found to have an MRI-visible prostate lesion underwent MRI-targeted and systematic prostate biopsy. Primary outcomes were clinically significant cancer detection rates by MRI-targeted, systematic biopsy, and combined biopsy across 4 discrete PSAD intervals (<0.1, 0.1 and <0.15, 0.15 and <0.2, and 0.2 ng/mL/cm3). Secondary outcomes were the added value of systematic biopsy relative to MRI-targeted biopsy alone.

Results: Among men with Prostate Imaging Reporting and Data System 2 lesions, as PSAD surpassed each interval, the rate of grade group 3 cancer detection approximately doubled (<0.1: 9.3%, 0.1 and <0.15: 18.2%, 0.15 and <0.2: 36%, and 0.2: 61.2%). For PSAD 0.2, added detection of clinically significant cancer with systematic biopsy was low (2%, 95% CI: 0.4%-5.9%).

Conclusions: Given an approximate doubling in grade group 3 cancer detection on combined biopsy with rising PSAD intervals, clinicians may consider PSAD in risk stratifying men at high risk of clinically significant prostate cancer. Clinicians may consider omitting systematic biopsy for targeted biopsy of MRI-visible lesions in patients with PSAD 0.2 ng/mL/cm3, as systematic biopsy results in low rates of additional clinically significant cancer detection.

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来源期刊
Journal of Urology
Journal of Urology 医学-泌尿学与肾脏学
CiteScore
11.50
自引率
7.60%
发文量
3746
审稿时长
2-3 weeks
期刊介绍: The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.
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