Combined Use of Prostate-specific Antigen Density and Magnetic Resonance Imaging for Prostate Biopsy Decision Planning: A Retrospective Multi-institutional Study Using the Prostate Magnetic Resonance Imaging Outcome Database

被引：73

作者：

Falagario, Ugo Giovanni ^{[1
,2
]}

Jambor, Ivan ^{[3
,4
,5
]}

Lantz, Anna ^{[2
,6
,7
]}

Ettala, Otto ^{[8
,9
]}

Stabile, Armando ^{[10
]}

Taimen, Pekka ^{[11
,12
]}

Aronen, Hannu J. ^{[4
,5
]}

Knaapila, Juha ^{[8
,9
]}

Perez, Ileana Montoya ^{[4
,5
]}

Gandaglia, Giorgio ^{[10
]}

Fossati, Nicola ^{[10
]}

Martini, Alberto ^{[2
,10
]}

Cucchiara, Vito ^{[10
]}

Picker, Wolfgang ^{[13
]}

Haug, Erik ^{[14
]}

Ratnani, Parita ^{[2
]}

Haines, Kenneth ^{[15
]}

Lewis, Sara ^{[3
]}

Sujit, Nair ^{[2
]}

Selvaggio, Oscar ^{[1
]}

Sanguedolce, Francesca ^{[16
]}

Macarini, Luca ^{[17
]}

Cormio, Luigi ^{[1
,18
]}

Nordstrom, Tobias ^{[6
,7
]}

Tewari, Ash ^{[2
]}

Briganti, Alberto ^{[10
]}

Bostrom, Peter J. ^{[8
,9
]}

Carrieri, Giuseppe ^{[1
]}

机构：

[1] Univ Foggia, Dept Urol & Organ Transplantat, Viale Pinto 1, I-71100 Foggia, Italy

[2] Icahn Sch Med Mt Sinai, Dept Urol, New York, NY 10029 USA

[3] Icahn Sch Med Mt Sinai, Dept Radiol, New York, NY 10029 USA

[4] Univ Turku, Dept Radiol, Turku, Finland

[5] Turku Univ Hosp, Med Imaging Ctr Southwest Finland, Turku, Finland

[6] Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden

[7] Karolinska Univ Hosp, Dept Urol, Solna, Sweden

[8] Univ Turku, Dept Urol, Turku, Finland

[9] Turku Univ Hosp, Turku, Finland

[10] IRCCS Osped San Raffaele, Urol Res Inst, Dept Oncol, Unit Urol, Milan, Italy

[11] Univ Turku, Inst Biomed, Turku, Finland

[12] Turku Univ Hosp, Dept Pathol, Turku, Finland

[13] Aleris Canc Ctr, Dept Radiol, Oslo, Norway

[14] Vestfold Hosp Trust, Sect Urol, Tonsberg, Norway

[15] Icahn Sch Med Mt Sinai, Dept Pathol, New York, NY 10029 USA

[16] Univ Foggia, Dept Pathol, Foggia, Italy

[17] Univ Foggia, Dept Radiol, Foggia, Italy

[18] Bonomo Teaching Hosp, Dept Urol, Andria, Italy

来源：

EUROPEAN UROLOGY ONCOLOGY | 2021年 / 4卷 / 06期

关键词：

Prostate cancer; Magnetic resonance imaging; Prostate-specific antigen density; Biopsy naive; Previous negative biopsy; CANCER; MRI;

D O I：

10.1016/j.euo.2020.08.014

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: Previous studies suggested that prostate-specific antigen (PSA) density (PSAd) combined with magnetic resonance imaging (MRI) may help avoid unnecessary prostate biopsy (PB) with a limited risk of missing clinically significant prostate cancer (csPCa; Gleason grade group [GGG] >1). Objective: To define optimal diagnostic strategies based on the combined use of PSAd and MRI in patients at risk of prostate cancer (PCa). Design, setting, and participants: A retrospective analysis of the international multicenter Prostate MRI Outcome Database (PROMOD), including 2512 men having undergone PSAd and prostate MRI before PB between 2013 and 2019, was performed. Outcome measurements and statistical analysis: Rates of avoided PB, missed GGG 1, and csPCa according to 10 strategies based on PSAd values and MRI reporting scores (Prostate Imaging Reporting and Data System [PI-RADS]/Likert/IMPROD biparametric prostate MRI Likert). Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy. Combined systematic and targeted biopsies were used for reference. Results and limitations: According to DCA, the best strategy in biopsy-naive patients was #7 (PI-RADS/Likert 4-5 or PI-RADS/Likert 3 if PSAd >0.2), which avoided 41.2% PBs while missed 44% of GGG 1 and 10.9% of csPCa cases. From a clinical standpoint, however, strategies with a lower risk of missing csPCa included #10 (PI-RADS/Likert 4-5 or PI-RADS 3 if PSAd >0.10 or PSAd >0.2), which avoided 27% PBs while missing 24.4% GGG 1 and 4% csPCa cases, or #5 (PI-RADS/Likert 3-5 or PSAd > 0.15), which avoided 14.7% PBs while missing 9.3% GGG 1 and 1.7% csPCa cases. Similar results were found in patients with a previous negative biopsy. This study is limited by its retrospective nature, and no central review of MRI and histopathological findings. Conclusions: Combined PSAd and MRI findings allows individualization of the decision to perform PB on the basis of the risk of missing PCa that both patients and clinicians are ready to accept to avoid this procedure. Patient summary: We compared several biopsy strategies based on a combination of prostate magnetic resonance imaging findings and prostate-specific antigen density, providing a readily available tool for each center and practicing urologist to counsel patients about their individual risk of significant prostate cancer. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

引用

页码：971 / 979

页数：9

共 20 条

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