Reliability of mpMRI in diagnosing cancer prostate following intravesical BCG for bladder cancer

IF 1.6 Q3 UROLOGY & NEPHROLOGY BJUI compass Pub Date : 2024-10-15 DOI:10.1002/bco2.446

Arjun Pon Avudaiappan, Pushan Prabhakar, Rachel Siretskiy, Andrew Renshaw, Ahmed Eldefrawy, Murugesan Manoharan

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Abstract

Background

Detecting carcinoma prostate (CaP) after intravesical Bacillus Calmette Guerin (BCG) immunotherapy for non-muscle invasive bladder cancer (NMIBC) poses diagnostic challenges. Granulomatous prostatitis (GP) has an incidence of 0.8%–3.3% in post-intravesical BCG patients and 6% incidence in a PIRADS 5 lesion on multiparametric MRI (mpMRI). Patients with GP after intravesical BCG may have clinical, biochemical, and radiological features similar to CaP. In our study, we evaluate the reliability of mpMRI in diagnosing CaP after intravesical BCG therapy.

Materials and Methods

We reviewed the NMIBC patients treated with intravesical BCG therapy between 2017 and 2023 and investigated those who underwent mpMRI and MR fusion biopsy in suspicion of CaP. A total of 120 patients had intravesical BCG immunotherapy, and 10 patients met our selection criteria. We performed a descriptive analysis of these patients and assessed the sensitivity and specificity of mpMRI in diagnosing CaP.

Results

The sensitivity of mpMRI in detecting CaP was 100%, and the specificity was 28.6%. Similarly, the negative predictive value for detecting CaP was 100%, and the positive predictive value was 37.5%. Among patients evaluated with mpMRI, a PIRADS 4 or 5 lesion was seen in 8 (80%) patients, and there was no lesion in 2 (20%) patients. The mpMRI detected 1 lesion in 6 patients (60%) and 2 (20%) in 2 patients. The lesions had a PIRADS score of 4 and 5 in 6 (60%) and 2 (20%) patients, respectively. Among these lesions, 8 (80%) were in the peripheral zone and 2 (20%) in the transition zone. In the MR fusion biopsy of these 10 patients, 7 (70%) had granulomatous prostatitis, and 3 (30%) had CaP.

Conclusion

In our study on evaluating the reliability of mpMRI in diagnosing CaP among post-intravesical BCG patients, we noted that although PIRADS in mpMRI had high sensitivity in identifying prostate lesions, its specificity for detecting CaP is limited.

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mpMRI诊断膀胱癌膀胱内卡介苗后前列腺癌的可靠性。

背景：膀胱内卡介苗（BCG）免疫疗法治疗非肌层浸润性膀胱癌（NMIBC）后，前列腺癌（CaP）的诊断面临挑战。肉芽肿性前列腺炎（GP）在膀胱内卡介苗治疗后患者中的发病率为 0.8%-3.3%，而在多参数磁共振成像（mpMRI）中，PIRADS 5 病变的发病率为 6%。膀胱内卡介苗后GP患者可能具有与CaP相似的临床、生化和放射学特征。在我们的研究中，我们评估了 mpMRI 在膀胱卡介苗治疗后诊断 CaP 的可靠性：我们回顾了2017年至2023年间接受膀胱内卡介苗治疗的NMIBC患者，并调查了因怀疑CaP而接受mpMRI和MR融合活检的患者。共有120名患者接受了膀胱内卡介苗免疫治疗，其中10名患者符合我们的选择标准。我们对这些患者进行了描述性分析，并评估了 mpMRI 诊断 CaP 的敏感性和特异性：结果：mpMRI 检测 CaP 的敏感性为 100%，特异性为 28.6%。同样，检测 CaP 的阴性预测值为 100%，阳性预测值为 37.5%。在使用 mpMRI 进行评估的患者中，8 例（80%）患者出现了 PIRADS 4 或 5 病变，2 例（20%）患者没有病变。mpMRI 在 6 名患者（60%）中发现 1 个病灶，在 2 名患者（20%）中发现 2 个病灶。6 名患者（60%）和 2 名患者（20%）的病灶 PIRADS 评分分别为 4 分和 5 分。在这些病灶中，8 个（80%）位于外周区，2 个（20%）位于过渡区。在这10名患者的磁共振融合活检中，7人（70%）患有肉芽肿性前列腺炎，3人（30%）患有CaP：我们在评估 mpMRI 诊断卡介苗术后患者 CaP 的可靠性的研究中发现，虽然 mpMRI 中的 PIRADS 在识别前列腺病变方面具有较高的灵敏度，但其检测 CaP 的特异性有限。

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