The role of PSA kinetics in men with a negative MRI-targeted prostate biopsy.

IF 1.5 Q3 UROLOGY & NEPHROLOGY American journal of clinical and experimental urology Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI:10.62347/IWIB8107
Marcelo P Bigarella, Arighno Das, Diana Garcia, Krista Brackman, Glenn Allen, David Jarrard
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Abstract

Objective: To evaluate rebiopsy rates and clinicopathologic outcomes in patients after a negative MRI-guided biopsy to better inform the management of these patients.

Methods: Patients were included with a clinical suspicion of prostate cancer (PCa) referred for fusion biopsy for a PI-RADS v2.1 lesion ≥ 3 on multiparametric MRI and a negative MRI fusion biopsy. Biopsies included targeted and systematic cores. Patients with a prior cancer diagnosis were excluded. Both baseline and follow-up clinicopathological data, and long-term PSA values were examined in these patients. Statistical analyses included Wilcoxon rank-sum test and one-way tests.

Results: Of 685 total patients, 188 (27%) had a negative fusion biopsy. Of these 88 (47%), 74 (39%), and 26 (14%) had PI-RADS 3, 4, 5 lesions, respectively. Complete follow-up was available for 182/188 patients (97%), with a median of 24 months (interquartile range: 12-38). Post-biopsy PSA levels decreased the first and the second year (-0.24; and -0.84 ng/ml/yrs respectively). In follow-up, 44 patients had an MRI (24%) and 20 had a biopsy (10%). A positive PSA velocity was the only predictive variable for repeat MRI in univariate analysis. On repeat MRI, 9 (27%) patients had disappearance of the initial lesion, 21 (48%) had a lower PIRADS score and 14 (32%) higher. Only 12/182 (6.6%) were found to have PCa during follow-up, of those 7 (3.8%) were clinically significant.

Conclusion: For patients with nonmalignant biopsy findings after an initial mpMRI showing a suspicious PI-RADS lesion, the majority of patients will have their PSAs return to baseline over time. To support this, repeat MRI frequently demonstrated a disappearance or downgrading of PIRADS lesions. These data support monitoring patients with this clinical scenario.

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PSA 动力学在 MRI 靶向前列腺活检阴性的男性中的作用。
目的:评估磁共振成像引导活检阴性患者的再活检率和临床病理结果:评估核磁共振成像引导活检阴性患者的再次活检率和临床病理结果,以便更好地指导这些患者的治疗:方法:纳入临床怀疑前列腺癌(PCa)的患者,这些患者因多参数磁共振成像(MRI)PI-RADS v2.1病变≥3且MRI融合活检阴性而转诊进行融合活检。活检包括靶向和系统性核芯活检。曾被诊断为癌症的患者不包括在内。对这些患者的基线和随访临床病理数据以及长期 PSA 值进行了检查。统计分析包括 Wilcoxon 秩和检验和单向检验:在685名患者中,188人(27%)的融合活检结果为阴性。其中88人(47%)、74人(39%)和26人(14%)分别患有PI-RADS 3、4和5病变。182/188名患者(97%)接受了完整的随访,中位随访时间为24个月(四分位间范围:12-38个月)。活检后的 PSA 水平在第一年和第二年有所下降(分别为-0.24 ng/ml/年和-0.84 ng/ml/年)。在随访中,44 名患者进行了核磁共振成像(24%),20 名患者进行了活组织检查(10%)。在单变量分析中,PSA 阳性是重复 MRI 的唯一预测变量。在复查磁共振成像时,9 名患者(27%)的初始病灶消失,21 名患者(48%)的 PIRADS 评分降低,14 名患者(32%)的评分升高。只有12/182(6.6%)例患者在随访期间发现了PCa,其中7例(3.8%)具有临床意义:结论:对于在初次 mpMRI 显示可疑 PI-RADS 病变后进行非恶性活检的患者,大多数患者的 PSA 会随着时间的推移恢复到基线水平。为了证明这一点,重复磁共振成像经常显示 PIRADS 病变消失或恶化。这些数据支持对这种临床情况的患者进行监测。
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