摘要
Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant disease.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has been explored as a staging modality for PCa.Less is known regarding its utility as a primary screening modality.We examined our experience with mpMRI as both a screening and staging instrument.Methods:mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography(TRUS)biopsy findings.Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant(Gleason score≥7)disease.Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy.mpMRI studies were also cross-referenced with RP specimens.Statistical analyses determined predictive ability of extracapsular extension(ECE),seminal vesicle involvement(SVI),and pathologic evidence of clinically significant disease(Gleason score7).Results:Four hundred biopsy naive or prior negative biopsy patients had positive mpMRI studies.Overall sensitivity,specificity,positive and negative predictive values were 94%,37%,58%,and 87%,respectively and 95%,31%,42%,and 93%,respectively for overall cancer detection and Gleason score≥7 disease.In patients with no prior biopsy history,mpMRI sensitivity,specificity,positive and negative predictive values were 94%,36%,65%,and 82%,for all cancers,and 95%,30%,50%,and 89%for Gleason score7 lesions,respectively.In those with prior negative biopsy sensitivity,specificity,positive and negative predictive values were 94%,37%,52%,and 90% for all cancers,and 96%,32%,36%,and 96% for Gleason score7 lesions,respectively.Seventy-four patients underwent radical prostatectomy(RP)after mpMRI.Lesion size on mpMRI correlated with the presence of Gleason score7 cancers(p Z 0.005).mpMRI sensitivity,specificity,positive and negative predictive values were 84%,39%,81%,and 44% respectively,for Gleason7 cancer.For ECE and SVI,sensitivity and specificity were 58% and 98% and 44% and 97%,respectively.Conclusion:mpMRI is an accurate predictor of TRUS biopsy and RP outcomes.mpMRI has significant potential to change PCa management,particularly in the screening population,in whom a significant proportion may avoid TRUS biopsy.Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.
