PSA和mpMRI检查在卡介苗膀胱灌注后肉芽肿性前列腺炎诊断中的应用价值

The diagnostic value of PSA and multi-parameter MRI in granulomatous prostatitis after intravesical Bacillus Calmette-Guérin therapy

目的探讨围手术期前列腺特异性抗原(PSA)和多参数磁共振成像(mpMRI)检查对卡介苗(BCG)膀胱灌注后肉芽肿性前列腺炎的诊断价值。方法回顾性分析2015年1月至2020年6月山东大学附属省立医院收治的8例因膀胱癌行BCG膀胱灌注后确诊肉芽肿性前列腺炎患者的病例资料。平均年龄63.6(47~76)岁。术前总前列腺特异性抗原(tPSA)1.78(0.45~3.62)ng/ml,f/tPSA 0.32(0.20~0.51)。前列腺mpMRI检查外周带T1WI为等信号、T2WI为高信号,均为正常前列腺MRI影像表现。所有患者均经膀胱镜检查+活检病理诊断为中高危非肌层浸润性膀胱癌并接受经尿道膀胱肿瘤切除术,术后均先行吉西他滨膀胱灌注4~6周后,再行BCG膀胱规律灌注治疗。结果本组8例接受BCG膀胱灌注治疗平均10.5(9~15)个月,复查tPSA 5.67(2.02~12.89)ng/ml,其中4例为6.77~12.89 ng/ml,4例为2.02~2.68 ng/ml;8例f/tPSA为0.12(0.09~0.15)。所有患者复查盆腔mpMRI均显示前列腺外周带异常信号,T2WI表现为低信号,DWI均表现为高信号,ADC图均表现为低信号,与BCG膀胱灌注前相比有显著差异,均怀疑前列腺癌并建议行穿刺活检。行经直肠超声引导下12针前列腺系统穿刺活检,病理均为肉芽肿性前列腺炎。结论非肌层浸润性膀胱癌患者行BCG膀胱灌注后PSA升高并出现前列腺mpMRI异常信号,可考虑为继发性肉芽肿性前列腺炎,结合BCG灌注史可能无需行前列腺穿刺活检。

Objective To evaluate the diagnostic value of serum prostate-specific antigen(PSA)levels and multi-parameter magnetic resonance imaging(mpMRI)in patients with granulomatous prostatitis after intravesical Bacillus Calmette-Guérin(BCG)therapy.Methods The medical records of eight patients with pathologically proven granulomatous prostatitis in Shandong Provincial Hospital Affiliated to Shandong University from January,2015 to June,2020,were enrolled and analyzed in this retrospective study.All 8 patients(ages 47-76,mean 63.6)underwent pelvic mpMRI and serum tPSA levels before TURBT,which showed the results of tPSA,f/t and mpMRI were normal before TURBT(0.45-3.62 ng/ml,0.20-0.51 and normal signal intensities on T1WI and T2WI,respectively).All patients underwent intravesical BCG therapy after post-TURBT 4-6-weeks’intravesical gemcitabine therapy as a result of pathologically proven middle and high risk NMIBC via cystoscopy.Results The results of tPSA levels in all 8 patients were elevated after intravesical BCG therapy after 9-15 months(mean 10.5 months),with 4 patients above 4(6.77-12.89)ng/ml and 4 patients within the normal ranges(2.02-2.68)ng/ml,and f/t levels decreased to lower than 0.16(0.09-0.15)in all patients.The mpMRI abnormal signals in all patients were all located in the peripheral zone of prostate.All nodular lesions of prostate mpMRI showed lower signal intensity(SI)on T2WI,higher SI on DWI and lower SI on ADC after BCG therapy.All patients underwent prostate biopsy for abnormal signal on prostate mpMRI.The biopsy pathologic results of all patients were granulomatous prostatitis.Conclusions When elevated PSA and abnormal signals on prostate mpMRI after intravesical BCG therapy occurred,prostate biopsy may not be required for secondary granulomatous prostatitis patients with non-muscle invasive bladder cancer in combination of clinical history.