基于bpMRI的前列腺活检对PSA≤20 ng/ml前列腺癌诊断价值的研究

The value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20 ng/ml

目的探讨基于双参数磁共振(bpMRI)的前列腺活检对PSA≤20ng/ml前列腺癌的诊断价值。方法回顾性分析2017年11至2019年10月南京医科大学第一附属医院行前列腺活检的394例患者的临床资料。其中177例行经直肠超声(TRUS)引导改良系统活检,为TRUS组;217例活检前行bpMRI检查,为MRI组,其中33例前列腺影像报告和数据系统(PI-RADS)评分<3分行改良系统活检,184例PI-RADS评分≥3分行系统活检+MRI-TRUS认知融合靶向活检。TRUS组中位年龄66(61,74)岁,前列腺特异性抗原(PSA)9.52(7.26,12.30)ng/ml,前列腺体积(PV)36.84(28.95,57.72)ml。MRI组中位年龄66(59,72)岁,PSA 8.84(6.65,12.16)ng/ml,PV 39.45(29.25,58.69)ml。两组上述一般资料差异均无统计学意义(P>0.05)。通过χ^(2)检验比较两组前列腺癌及有临床意义前列腺癌(CsPCa)检出率之间的差异。结果TRUS组和MRI组前列腺癌检出率差异无统计学意义[51.41%(91/177)与48.39%(105/217),P=0.550],但CsPCa检出率差异有统计学意义[26.55%(47/177)和36.41%(79/217),P=0.037]。在PSA≤10 ng/ml的患者中,两组前列腺癌检出率差异无统计学意义[43.62%(41/94)与43.08%(56/130),P=0.936],CsPCa检出率差异有统计学意义[17.02%(16/94)与28.46%(37/130),P=0.047]。在10<PSA≤20 ng/ml患者中,TRUS组与MRI组前列腺癌检出率[60.24%(50/83)与56.17%(48/87),P=0.504]和CsPCa检出率[37.35%(31/83)与48.28%(42/87),P=0.150]差异均无统计学意义。TRUS组和MRI组最后2针前列腺癌检出率分别为23.16%(41/177)和36.63%(86/217),差异有统计学意义(P=0.001);最后2针CsPCa检出率分别为11.86%(26/177)和29.03%(63/217),差异有统计学意义(P<0.001)。MRI组患者中,PI-RADS评分<3、3、4、5分患者前列腺癌检出率分别为21.21%(7/33)、25.84%(23/89)、73.24%(52/71)、95.83%(23/24);CsPCa检出率分别为12.12%(4/33)、17.98%(16/89)、54.93%(39/71)、83.33%(23/24),随着PI-RADS评分升高,前列腺癌和CsPCa检出率均逐渐升高(P<0.001)。结论在PSA≤20ng/ml患者中,基于bpMRI的前列腺活检可提高CsPCa的检出率,尤其是在PSA≤10 ng/ml患者中。

Objective To detect the value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20ng/ml.Methods The clinical data of 394 patients who underwent prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from November 2017 to October 2019 were retrospectively analyzed.Of all the patients,177 underwent modified systematic biopsy,named TRUS group,217 patients accepted pre-biopsy bpMRI examination,undergoing modified systematic biopsy if Prostate Imaging Reporting and Data System(PI-RADS)score<3 or MRI-TRUS cognitive fusion targeted prostate+systematic biopsy if PI-RADS score≥3,named MRI group.The median age of TRUS group was 66(61,74)years old,prostate specific antigen(PSA)was 9.52(7.26,12.30)ng/ml,and prostate volume(PV)was 36.84(28.95,57.72)ml.The median age of MRI group was 66(59,72)years old,PSA was 8.84(6.65,12.16)ng/ml,and PV was 39.45(29.25,58.69)ml.There was no difference in above parameters between the two groups.Theχ^(2)test was used to compare the detection rate of prostate cancer and clinically significant prostate cancer(CsPCa)between the two groups.Results There was no significant difference in the detection rates of prostate cancer between TRUS group and MRI group[51.41%(91/177)vs.48.39%(105/217),P=0.550],but the detection rates of CsPCa were significantly different[26.55%(47/177)vs.36.41%(79/217),P=0.037].In patients with PSA≤10 ng/ml,there was no significant difference in the detection rates of prostate cancer between the two groups[43.62%(41/94)vs.43.08%(56/130),P=0.936],but there was a significant difference in the detection rates of CsPCa[17.02%(16/94)vs.28.46%(37/130),P=0.047].There was no significant difference in the detection rates of prostate cancer[60.24%(50/83)and 56.17%(48/87),P=0.504]and the detection rates of CsPCa[37.35%(31/83)vs.48.28%(42/87),P=0.150]between the two groups.The total detection rates of the last two needles in TRUS group and MRI group were 23.16%(41/177)and 36.63%(86/217),respectively,with significant difference(P=0.001);the detection rates of CsPCa in the last two needles were 11.86%(26/177)and 29.03%(63/217),respectively,with significant difference(P<0.001).In MRI group,the detection rates of prostate cancer in patients with PI-RADS score<3,3,4,5 were 21.21%(7/33),25.84%(23/89),73.24%(52/71),95.83%(23/24),respectively;the detection rates of CsPCa were 12.12%(4/33),17.98%(16/89),54.93%(39/71),83.33%(23/24),respectively.Conclusions In patients with PSA≤20 ng/ml,prostate biopsy based on bpMRI may improve the detection of CsPCa,especially in patients with PSA≤10 ng/ml.