Multiparametric Magnetic Resonance Imaging in Prostate Cancer Screening at the Age of 45 Years: Results from the First Screening Round of the PROBASE Trial

被引：27

作者：

Boschheidgen, Matthias ^{[1
]}

Albers, Peter ^{[2
,3
]}

Schlemmerd, Heinz -Peter ^{[4
]}

Hellms, Susanne ^{[5
]}

Bonekamp, David ^{[4
]}

Sauterf, Andreas ^{[6
]}

Hadaschikg, Boris ^{[7
,8
]}

Krilaviciute, Agne ^{[3
]}

Radtke, Jan Philipp ^{[2
]}

Seibold, Petra ^{[3
]}

Lakes, Jale ^{[2
]}

Arsov, Christian ^{[2
,9
]}

Gschwend, Juergen E. ^{[10
]}

Herkommeri, Kathleen ^{[10
]}

Makowsk, Marcus ^{[6
]}

Kuczyk, Markus A. ^{[10
]}

Wacker, Frank ^{[5
]}

Harke, Nina ^{[11
]}

Debus, Juergen ^{[3
,12
]}

Korber, Stefan A. ^{[3
,12
]}

Benner, Axel ^{[4
,13
]}

Kristiansen, Glen ^{[14
]}

Giesel, Frederik L. ^{[15
]}

Antoch, Gerald ^{[1
,16
]}

Kaaksp, Rudolf ^{[17
]}

Beckerc, Nikolaus ^{[3
]}

Schimmoelleraq, Lars ^{[1
,18
]}

机构：

[1] Dusseldorf Univ, Med Fac, Dept Diagnost & Intervent Radiol, Moorenstr 5, D-40225 Dusseldorf, Germany

[2] Univ Dusseldorf, Med Fac, Dept Urol, D-40225 Dusseldorf, Germany

[3] German Canc Res Ctr, Div Personalized Early Detect Prostate Canc, Heidelberg, Germany

[4] German Canc Res Ctr, Dept Radiol, Heidelberg, Germany

[5] Inst Diagnost & Intervent Radiol, Hannover Med Sch, Hannover, Germany

[6] Tech Univ Munich, Sch Med, Dept Diagnost & Intervent Radiol, Klinikum Rechts Isar, Munich, Germany

[7] Univ Duisburg Essen, Dept Urol, Essen, Germany

[8] Univ Hosp Essen, German Canc Consortium dktk, Essen, Germany

[9] Elisabeth Krankenhaus Rheydt, Dept Urol & Paediat Urol, Stadt Kliniken Monchengladbach GmbH, Monchengladbach, Germany

[10] Tech Univ Munich, Sch Med & Hlth, Dept Urol, Munich, Germany

[11] Hannover Med Sch, Dept Urol, Hannover, Germany

[12] Heidelberg Univ Hosp, Ruprecht Karls Univ, Dept Radiat Oncol, Heidelberg, Germany

[13] German Canc Res Ctr, Div Biostat, Heidelberg, Germany

[14] Univ Hosp Bonn, Inst Pathol, Bonn, Germany

[15] Univ Dusseldorf, Med Fac, Dept Nucl Med, D-40225 Dusseldorf, Germany

[16] Ctr Integrated Oncol Aachen Bonn Cologne Dusseldor, Dusseldorf CIO ABCD, Dusseldorf, Germany

[17] German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany

[18] Univ Bochum, Univ Hosp Ruhr, Marien Hosp Herne, Dept Diagnost, Herne, Germany

来源：

EUROPEAN UROLOGY | 2024年 / 85卷 / 02期

关键词：

Prostatic neoplasms; Screening; Multiparametric magnetic resonance imaging; Magnetic resonance imaging; Interventional; MEN; MRI;

D O I：

10.1016/j.eururo.2023.09.027

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Magnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening. Objective: To determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA). Design, setting, and participants: Participants with confirmed PSA >= 3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 Outcome measurements and statistical analysis: The local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4). Results and limitations: Of 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group >= 2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS <3. If PI-RADS >= 4 were to be used as a biopsy cutoff, mpMRI would reduce negative biopsies by 68% and avoid detection of nonsignificant PC in 71% of cases. Conclusions: Prostate MRI in a young screening population is difficult to read. The MRI accuracy of for csPC detection is highly dependent on reader experience, and double reading might be advisable. More data are needed before MRI is included in PC screening for men at age 45 yr.

引用

页码：105 / 111

页数：7

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