Objective: To evaluate the efficacy of endorectal Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spetroscopic Imaging (MRSI) combined with total prostate-specific antigen (tPSA) and free prostate-specific ant...Objective: To evaluate the efficacy of endorectal Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spetroscopic Imaging (MRSI) combined with total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) in selecting candidates for biopsy. Subjects and Methods: 246 patients with elevated tPSA (median: 7.81 ng/ml) underwent endorectal MRI and MRSI before Transrectal Ultrasound (TRUS) biopsy (10 peripheral + 2 central cores);patients with positive biopsies were treated with radical intention;those with negative biopsies were followed up and underwent MRSI before each additional biopsy if tPSA rose persistently. Mean follow-up: 27.6 months. We compared MRI, MRSI, tPSA, and fPSA with histopathology by sextant and determined the association between the Gleason score and MRI and MRSI. We determined the most accurate combination to detect prostate cancer (PCa) using receiver operating curves;we estimated the odds ratios (OR) and calculated sensitivity, specificity, and positive and negative predictive values. Results: No difference in tPSA was found between patients with and without PCa (p = 0.551). In the peripheral zone, the risk of PCa increased with MRSI grade;patients with high-grade MRSI had the greatest risk of PCa over time (OR = 328.6);the model including MRI, MRSI, tPSA, and fPSA was more accurate (Area under Curve: AUC = 95.7%) than MRI alone (AUC = 85.1%) or fPSA alone (AUC = 78.1%), but not than MRSI alone (94.5%). In the transitional zone, the model was less accurate (AUC = 84.4%). The association (p = 0.005) between MRSI and Gleason score was significant in both zones. Conclusions: MRSI is useful in patients with elevated tPSA. High-grade MRSI lesions call for repeated biopsies. Men with negative MRSI may forgo further biopsies because a significantly high Gleason lesion is very unlikely.展开更多
文摘Objective: To evaluate the efficacy of endorectal Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spetroscopic Imaging (MRSI) combined with total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) in selecting candidates for biopsy. Subjects and Methods: 246 patients with elevated tPSA (median: 7.81 ng/ml) underwent endorectal MRI and MRSI before Transrectal Ultrasound (TRUS) biopsy (10 peripheral + 2 central cores);patients with positive biopsies were treated with radical intention;those with negative biopsies were followed up and underwent MRSI before each additional biopsy if tPSA rose persistently. Mean follow-up: 27.6 months. We compared MRI, MRSI, tPSA, and fPSA with histopathology by sextant and determined the association between the Gleason score and MRI and MRSI. We determined the most accurate combination to detect prostate cancer (PCa) using receiver operating curves;we estimated the odds ratios (OR) and calculated sensitivity, specificity, and positive and negative predictive values. Results: No difference in tPSA was found between patients with and without PCa (p = 0.551). In the peripheral zone, the risk of PCa increased with MRSI grade;patients with high-grade MRSI had the greatest risk of PCa over time (OR = 328.6);the model including MRI, MRSI, tPSA, and fPSA was more accurate (Area under Curve: AUC = 95.7%) than MRI alone (AUC = 85.1%) or fPSA alone (AUC = 78.1%), but not than MRSI alone (94.5%). In the transitional zone, the model was less accurate (AUC = 84.4%). The association (p = 0.005) between MRSI and Gleason score was significant in both zones. Conclusions: MRSI is useful in patients with elevated tPSA. High-grade MRSI lesions call for repeated biopsies. Men with negative MRSI may forgo further biopsies because a significantly high Gleason lesion is very unlikely.
文摘目的:探讨u PCA3m RNA、t PSA、f PSA/t PSA、PSAD对PSA灰区前列腺癌的诊断价值。方法:经前列腺穿刺活检诊断为前列腺增生(BPH)111例和前列腺癌(PCa)89例,测定血清t PSA、f PSA与前列腺体积,所有病例均计算f PSA/t PSA、PSAD。用RT-PCR的方法检测PSA m RNA、PCA3 m RNA的含量,以PCA3 m RNA/PSA m RNA表示PCA3 m RNA的含量。比较两组间t PSA、f PSA/t PSA、PSAD及PCA3m RNA各指标的差异,分析各指标在ROC曲线下的面积、各指标的诊断敏感性和特异性。结果:PCa组的f PSA/t PSA较BPH组降低(P<0.01),PCa组的t PSA、PSAD及PCA3 m RNA较BPH组均升高(P<0.01)。t PSA、f PSA/t PSA、PSAD及PCA3 m RNA在ROC曲线下的面积从大到小依次是PCA3 m RNA>PSAD>f PSA/t PSA>t PSA。当PCA3 m RNA和PSAD临界值分别为0.27和0.15时,诊断PCa的敏感性和特异性分别是86.5%和77.5%,80.9%和55.9%。结论:u PCA3m RNA、f PSA/t PSA、PSAD的测定能显著提高灰区PCa诊断的敏感性和特异性,且u PCA3 m RNA诊断效能最高。
