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目的探讨多参数MRI PI-RADS评分1~2分患者前列腺癌及有临床意义前列腺癌(CsPCa)的检出率,分析该类患者诊断前列腺癌的危险因素。方法回顾性分析2011年7月至2018年6月行多参数MRI检查并行经直肠12针前列腺系统穿刺的196例患者的临床资料。患者年龄(66.6±9.0)岁,中位前列腺特异性抗原(PSA)7.44(4.93,10.98)ng/ml,中位前列腺体积63(43,78)ml。196例PI-RADS评分1~2分;28例PSA<4 ng/ml,前列腺指检异常;168例PSA>4 ng/ml。前列腺癌如满足以下任一条:PSA密度>0.15 ng/ml2,Gleason评分>6分,≥3针阳性,肿瘤≥50%穿刺长度,则诊断为CsPCa。分析前列腺癌及CsPCa的危险因素,单因素分析采用χ2检验或Fisher’s确切概率法,多因素分析采用logistic回归。结果196例中42例(21.4%)病理证实为前列腺癌,其中30例(15.3%)为CsPCa。多参数MRI诊断前列腺癌的阴性预测值为78.6%(154/196),诊断CsPCa的阴性预测值为84.7%(166/196)。单因素分析结果显示,患者年龄、PSA密度越高,前列腺癌阳性率越高;年龄、PSA、PSA密度越高,f/tPSA越低,则CsPCa的比例越高,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,PSA密度>0.15 ng/ml2(OR=2.94,95%CI 1.45~5.95,P<0.05)是前列腺癌的独立危险因素;年龄>70岁(OR=2.49,95%CI 1.22~5.07)、f/tPSA<0.2(OR=3.70,95%CI 1.25~11.23)、PSA密度>0.15 ng/ml2(OR=5.77,95%CI 1.96~16.96)是CsPCa的独立危险因素(均P<0.05)。结论对于PSA升高或前列腺指检异常的PI-RADS评分1~2分患者,前列腺癌检出率为21.4%,PSA密度>0.15 ng/ml2是前列腺癌的独立危险因素;CsPCa检出率为15.3%,年龄>70岁、f/tPSA<0.2、PSA密度>0.15 ng/ml2是其独立危险因素。 相似文献
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Presti J 《Current urology reports》2008,9(3):226-230
Risk assessment is critical to providing appropriate counseling and treatment for patients diagnosed with prostate cancer.
The three classic clinical parameters to determine risk have been clinical stage, biopsy grade, and prostate-specific antigen
(PSA) level. More recently, the importance of PSA kinetics has been realized in the pretreatment and serologic relapse settings.
This article reviews the use of PSA velocity and PSA doubling time in several clinical scenarios. 相似文献
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Hameed Maira Ganeshan Balaji Shur Joshua Mukherjee Subhabrata Afaq Asim Hellawell Giles Batura Deepak 《International urology and nephrology》2019,51(7):1171-1171
International Urology and Nephrology - Unfortunately, in the original article one co-author’s name is missing. The co-author name and affiliation is given as follows. 相似文献
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A urinary biomarker‐based risk score correlates with multiparametric MRI for prostate cancer detection 下载免费PDF全文
Rianne J. Hendriks Marloes M. G. van der Leest Siebren Dijkstra Jelle O. Barentsz Wim Van Criekinge Christina A. Hulsbergen‐van de Kaa Jack A. Schalken Peter F. A. Mulders Inge M. van Oort 《The Prostate》2017,77(14):1401-1407
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《Urologic oncology》2020,38(7):637.e9-637.e15
ObjectivesWe sought to identify clinical and magnetic resonance imaging (MRI) characteristics in men with the Prostate Imaging - Reporting and Data System (PI-RADS) category 3 index lesions that predict clinically significant prostate cancer (CaP) on MRI targeted biopsy.Materials and MethodsMulticenter study of prospectively collected data for biopsy-naive men (n = 247) who underwent MRI-targeted and systematic biopsies for PI-RADS 3 index lesions. The primary endpoint was diagnosis of clinically significant CaP (Grade Group ≥2). Multivariable logistic regression models assessed for factors associated with clinically significant CaP. The probability distributions of clinically significant CaP based on different levels of predictors of multivariable models were plotted in a heatmap.ResultsMen with clinically significant CaP had smaller prostate volume (39.20 vs. 55.10 ml, P < 0.001) and lower apparent diffusion coefficient (ADC) values (973 vs. 1068 μm2/s, P = 0.013), but higher prostate-specific antigen (PSA) density (0.21 vs. 0.13 ng/ml2, P = 0.027). On multivariable analyses, lower prostate volume (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92–0.97), lower ADC value (OR: 0.99, 95% CI: 0.99–1.00), and Prostate-specific antigen density >0.15 ng/ml2 (OR: 3.51, 95% CI 1.61–7.68) were independently associated with significant CaP.ConclusionHigher PSA density, lower prostate volume and ADC values are associated with clinically significant CaP in biopsy-naïve men with PI-RADS 3 lesions. We present regression-derived probabilities of detecting clinically significant CaP based on various clinical and imaging values that can be used in decision-making. Our findings demonstrate an opportunity for MRI refinement or biomarker discovery to improve risk stratification for PI-RADS 3 lesions. 相似文献
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Hannes Cash Andreas Maxeiner Carsten Stephan Thomas Fischer Tahir Durmus Josephine Holzmann Patrick Asbach Matthias Haas Stefan Hinz Jörg Neymeyer Kurt Miller Karsten Günzel Carsten Kempkensteffen 《World journal of urology》2016,34(4):525-532
Purpose
To evaluate the performance of real-time MRI/ultrasound (MRI/US) fusion-guided targeted biopsy (TB) in men with primary and repeat biopsies and correlate the prostate cancer detection rate (CDR) with the PI-RADS score.Methods
Analysis included 408 consecutive men with primary and prior negative biopsies who underwent TB and 10-core random biopsy (RB) between January 2012 and January 2015. TB was performed with a real-time MRI/US fusion platform with sensor-based registration. Clinically significant PCa was defined as Gleason score (GS) ≥7 or GS 6 with maximal cancer core length ≥4 mm for TB and according to Epstein criteria for RB.Results
The overall CDR was 56 % (227/408). The CDR for primary biopsy was 74 % (60/81) and 57 % (67/117), 49 % (62/126), 45 % (38/84) for patients with 1, 2 and ≥3 prior negative biopsies. CDRs correlated with PI-RADS 2/3/4/5 were 16 % (5/32), 26 % (29/113), 62 % (94/152) and 89 % (99/111), respectively. The rates of significant tumors in relation to PI-RADS 2/3/4/5 were 60 % (3/5), 66 % (19/29), 74 % (70/94), 95 % (94/99). In 139 (61 %) cases with radical prostatectomy (RP), the rates of ≥pT3 tumors in correlation with PI-RADS 4 and 5 were 20 % (11/56) and 49 % (32/65). PI-RADS constituted the strongest predictor of significant PCa detection (p < 0.007).Conclusions
Real-time MRI/US fusion-guided TB combined with RB improved PCa detection in patients with primary and repeat biopsies. The CDR was strongly correlated with a rising PI-RADS score, values of 4 and 5 increasing the detection of clinically significant tumors and leading to a higher histological stage after RP.12.
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First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer 总被引:1,自引:0,他引:1
Blana A Murat FJ Walter B Thuroff S Wieland WF Chaussy C Gelet A 《European urology》2008,53(6):1194-1201
OBJECTIVE: To evaluate the long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for patients with localised prostate cancer. MATERIAL AND METHODS: Patients included in this multicentre analysis had T1-T2 NxM0 prostate cancer, a PSA<15 ng/ml, and a Gleason score (GS) < or = 7, and were treated with prototypes or first-generation Ablatherm HIFU devices between October 1997 and August 2001. The Phoenix definition of biochemical failure was used (PSA nadir+2). Treatment failure was defined as: biochemical failure or positive biopsy. RESULTS: A total of 140 patients with a mean (SD) age 69.1 yr (6.6) were included. Mean (SD) follow-up was 6.4 yr (1.1). Control prostate biopsies were negative in 86.4% of patients. Median PSA nadir of 0.16 ng/ml (range, 0.0-9.1) was achieved at a mean (SD) of 4.9 mo (5.2). A PSA nadir < or = 0.5 ng/ml was recorded in 68.4% of patients. The actuarial biochemical failure-free survival rates (SR) at 5 and 7 yr were 77% and 69%, respectively. The actuarial disease-free SR at 5 and 7 yr were 66% and 59%, respectively. CONCLUSIONS: This study demonstrates the effective long-term cancer control achieved with HIFU in patients with low- or intermediate-risk localised prostate cancer. 相似文献
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E. Di Trapani S. Luzzago G. Peveri M. Catellani M. Ferro G. Cordima F.A. Mistretta R. Bianchi G. Cozzi S. Alessi D.V. Matei V. Bagnardi G. Petralia G. Musi O. De Cobelli 《Urologic oncology》2021,39(7):431.e15-431.e22
PurposeTo develop a novel risk tool that allows the prediction of lymph node invasion (LNI) among patients with prostate cancer (PCa) treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND).MethodsWe retrospectively identified 742 patients treated with RARP + ePLND at a single center between 2012 and 2018. All patients underwent multiparametric magnetic resonance imaging (mpMRI) and were diagnosed with targeted biopsies. First, the nomogram published by Briganti et al. was validated in our cohort. Second, three novel multivariable logistic regression models predicting LNI were developed: (1) a complete model fitted with PSA, ISUP grade groups, percentage of positive cores (PCP), extracapsular extension (ECE), and Prostate Imaging Reporting and Data System (PI-RADS) score; (2) a simplified model where ECE score was not included (model 1); and (3) a simplified model where PI-RADS score was not included (model 2). The predictive accuracy of the models was assessed with the receiver operating characteristic-derived area under the curve (AUC). Calibration plots and decision curve analyses were used.ResultsOverall, 149 patients (20%) had LNI. In multivariable logistic regression models, PSA (OR: 1.03; P= 0.001), ISUP grade groups (OR: 1.33; P= 0.001), PCP (OR: 1.01; P= 0.01), and ECE score (ECE 4 vs. 3 OR: 2.99; ECE 5 vs. 3 OR: 6.97; P< 0.001) were associated with higher rates of LNI. The AUC of the Briganti et al. model was 74%. Conversely, the AUC of model 1 vs. model 2 vs. complete model was, respectively, 78% vs. 81% vs. 81%. Simplified model 1 (ECE score only) was then chosen as the best performing model. A nomogram to calculate the individual probability of LNI, based on model 1 was created. Setting our cut-off at 5% we missed only 2.6% of LNI patients.ConclusionsWe developed a novel nomogram that combines PSA, ISUP grade groups, PCP, and mpMRI-derived ECE score to predict the probability of LNI at final pathology in RARP candidates. The application of a nomogram derived cut-off of 5% allows to avoid a consistent number of ePLND procedures, missing only 2.6% of LNI patients. External validation of our model is needed. 相似文献
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A multiparametric magnetic resonance imaging‐based risk model to determine the risk of significant prostate cancer prior to biopsy 下载免费PDF全文
Pim J. van Leeuwen Andrew Hayen James E. Thompson Daniel Moses Ron Shnier Maret Böhm Magdaline Abuodha Anne‐Maree Haynes Francis Ting Jelle Barentsz Monique Roobol Justin Vass Krishan Rasiah Warick Delprado Phillip D. Stricker 《BJU international》2017,120(6):774-781
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S. Kaufmann J. Bedke S. Gatidis J. Hennenlotter U. Kramer M. Notohamiprodjo K. Nikolaou A. Stenzl S. Kruck 《World journal of urology》2016,34(4):509-515
Purpose
Multiparametric magnetic resonance imaging (mpMRI) improves diagnostic accuracy in re-biopsies of men with prostate cancer (PC) suspicion, but predictive value is limited despite the use of the new Prostate Imaging Reporting and Data System (PI-RADS). Prognostic value of the PC-specific biomarker prostate cancer gene 3 (PCA3) added to the PI-RADS score was evaluated.Methods
The study was a retrospective analysis of the institutional database for men with MR-guided biopsy (MR-GB) for suspicious lesion in mpMRI and who had an additional pre-MR-GB PCA3 testing for ongoing PC suspicion. All men had ≥1 negative ultrasound GB. Lesions were retrospectively scored by PI-RADS in three MRI sequences (T2w, DCE, and DWI). PCA3 was analyzed with cutoffs of 25 and 35. The prognostic value of mpMRI and PCA3 and the additional value of both were explored.Results
Tumor detection rate (49 men, mean PSA 10 ng/ml, lesion size 40 mm2) was 45 % (22/49 patients). In the subgroup of PI-RADS IV°, 17/17 patients had PC; in PI-RADS III° (intermediate) 5/15 had PC, and all 5 had a PCA3 >35. PCA3 >35 had no additional prognostic value in the whole cohort. Out of the 10/15 PC negative patients (PI-RADS III°), PCA3 was <35 in 6. The inclusion of PCA3 value in PI-RADS III° patients improved predictive accuracy to 91.8 %.Conclusion
MpMRI and subsequent grading to PI-RADS significantly improves PC detection in the re-biopsy setting. The diagnostic uncertainty in the PI-RADS intermediate group can be ameliorated by the addition of PCA3 cutoff of 35 to avoid potential unnecessary biopsies.19.
《Urologic oncology》2020,38(6):599.e9-599.e13
Background and ObjectiveTo determine the effect of multiplicity of prostate imaging reporting and data system assessment category 3 (PI-RADS 3) lesions on cancer detection rate (CDR) of confirmatory targeted biopsy of such lesion in patients diagnosed with prostate cancer and managed with active surveillance.MethodsThis study was conducted at a single academic institution. There were 91 men with ≥ 1 PI-RADS 3 lesion detected through magnetic resonance imaging (MRI) after systematic prostate biopsy in the course of management of patients diagnosed with prostate cancer with active surveillance. We compared the CDRs based on targeted biopsy of PI-RADS 3 lesions that occurred (1) as solitary lesions, (2) as 1 of multiple PI-RADS 3 only lesions, or (3) with ≥ 1 higher grade lesion.ResultsMedian age was 65.0 years (interquartile range 59.5–70.0), median prostate specific antigen was 5.95 ng/ml (interquartile range 4.30–8.83), and median prostate specific antigen density was 0.161 ng/ml2 (0.071–0.194). Forty-three men had solitary PI-RADS 3 lesions, 22 had multiple PI-RADS 3 only lesions, and 26 had multiple lesions with ≥ 1 higher grade lesion. The overall CDR (Gleason score ≥ 3 + 3) based on confirmatory MRI targeted biopsy in a given PI-RADS 3 lesion in each group was 23%, 45%, and 54%, respectively (P = 0.0274). The CDRs for clinically significant disease (Gleason score ≥ 3 + 4) were 16%, 32%, and 35%, respectively (P = 0.1701).ConclusionsCoexisting lesions increase the CDR of confirmatory MRI targeted biopsy of PI-RADS 3 lesions in patients managed with active surveillance. Risk stratification algorithms for PI-RADS 3 lesion to guide biopsy and management decisions may consider including multiplicity of lesions. 相似文献
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Bernard H.E. Jansen Jakko A. Nieuwenhuijzen Daniela E. Oprea-Lager Marit J. Yska Anne P. Lont Reindert J.A. van Moorselaar André N. Vis 《Urologic oncology》2019,37(3):181.e1-181.e6