结合磁共振成像和前列腺特异性抗原密度对前列腺特异性抗原4-20 ng/mL患者前列腺活检选择的分区特异性风险分层优化

IF 2.5 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Prostate Pub Date : 2025-10-05 DOI:10.1002/pros.70075

Liqin Yang, Ximing Wang, Zhiping Li, Fawei Huang, Yongsheng Zhang, Feng Cui, Pengfei Jin

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引用次数: 0

摘要

目的：探讨外周区（PZ）和过渡区（TZ）病变MRI和前列腺特异性抗原（PSA）密度（PSAD）的分层差异，以优化PSA 4 ~ 20 ng/mL患者的活检决策。方法：回顾性分析1524例接受MRI和活检的患者。将病变按PZ和TZ分组，探讨亚组内PSAD的差异。通过整合前列腺成像报告和数据系统（PI-RADS）类别和PSAD在整体、PZ和TZ队列中构建区域特异性风险矩阵。根据PZ和TZ的10%或30%临床显著性前列腺癌（csPCa）概率构建低阈或高阈通路。然后形成六条活检途径，并通过活检避免、csPCa检测和阳性预测值（PPV）进行评估。最后，采用决策曲线分析（DCA）来评估与各途径相关的净效益。结果：PZ病变在等效PI-RADS分类中的PSAD高于TZ病变（p < 3），当PZ≥0.20 ng/mL/cm3时，csPCa风险达到10%。对于PI-RADS 3病变，阈值≥0.15 ng/mL/cm3 （TZ）和≥0.20 ng/mL/cm3 （PZ）触发活检，csPCa风险为bb0 ~ 30%。6条通路中，“PZ高+ TZ高”通路（PI-RADS 3中PSAD≥0.20 ng/mL/cm3为PZ， PSAD≥0.15 ng/mL/cm3为TZ）达到最佳平衡，检出86.6%的csPCa，避免48.0%的不必要活检，PPV为69.1% （f1评分= 0.77）。DCA证实，在风险阈值≥20%时，该途径具有优越的临床净获益。结论：在MRI和PSAD的风险分层中，考虑病变的分区特异性有助于改善PSA 4 ~ 20 ng/mL患者的活检决策。

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Zonal-Specific Risk Stratification Integrating Magnetic Resonance Imaging and Prostate-Specific Antigen Density for Optimizing Prostate Biopsy Selection in Prostate-Specific Antigen 4-20 ng/mL Patients.

Objective: To explore the stratification differences of MRI and prostate-specific antigen (PSA) density (PSAD) in the peripheral zone (PZ) and transition zone (TZ) lesions, in order to optimize the biopsy decision for patients with PSA 4-20 ng/mL.

Methods: This retrospective study analyzed 1524 patients undergoing MRI and biopsy. Lesions were grouped by PZ and TZ and the differences of PSAD within the subgroups were explored. A zonal-specific risk matrix was constructed by integrating the Prostate Imaging Reporting and Data System (PI-RADS) categories and PSAD in overall, PZ, and TZ cohorts. Low or high-threshold pathway was constructed by 10% or 30% clinically significant prostate cancer (csPCa) probability for PZ and TZ. Six biopsy pathways were then formed and evaluated by the biopsy avoidance, csPCa detection, and positive predictive value (PPV). Finally, decision curve analysis (DCA) was employed to evaluate the net benefit associated with each pathway.

Results: PZ lesions exhibited higher PSAD than TZ counterparts in equivalent PI-RADS categories (p < 0.05). In the risk matrix, for PI-RADS 1-2 lesions, TZ required PSAD ≥ 0.15 ng/mL/cm³ while PZ ≥ 0.20 ng/mL/cm³ to achieve > 10% csPCa risk. For PI-RADS 3 lesions, thresholds were ≥ 0.15 ng/mL/cm³ (TZ) and ≥ 0.20 ng/mL/cm³ (PZ) to trigger biopsy at > 30% csPCa risk. Among six pathways, the "PZ high + TZ high" pathway (PSAD ≥ 0.20 ng/mL/cm³ for PZ and ≥ 0.15 ng/mL/cm³ for TZ in PI-RADS 3) achieved optimal balance, detecting 86.6% of csPCa while avoiding 48.0% of unnecessary biopsies, with a PPV of 69.1% (F1-score = 0.77). DCA confirmed superior net clinical benefit for this pathway at ≥ 20% risk thresholds.

Conclusion: In the risk stratification of MRI and PSAD, considering zonal specific of the lesion is helpful to improve biopsy decisions in patients with PSA 4-20 ng/mL.

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来源期刊

Prostate 医学-泌尿学与肾脏学

CiteScore

5.10

自引率

3.60%

发文量

180

审稿时长

1.5 months

期刊介绍： The Prostate is a peer-reviewed journal dedicated to original studies of this organ and the male accessory glands. It serves as an international medium for these studies, presenting comprehensive coverage of clinical, anatomic, embryologic, physiologic, endocrinologic, and biochemical studies.