Optimal PSA Threshold for Obtaining MRI-Fusion Biopsy in Biopsy-Naïve Patients.

IF 2.3 Q3 ONCOLOGY Prostate Cancer Pub Date : 2021-07-01 eCollection Date: 2021-01-01 DOI:10.1155/2021/5531511
Luke L Wang, Brandon L Henslee, Peter B Sam, Chad A LaGrange, Shawna L Boyle
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Abstract

Objective: The study investigates the prostate-specific antigen threshold for adding targeted, software-based, magnetic resonance imaging-ultrasound fusion biopsy during a standard 12-core biopsy in biopsy-naïve patients. It secondarily explores whether the targeted biopsy is necessary in setting of abnormal digital rectal examination.

Methods: 260 patients with suspected localized prostate cancer with no prior biopsy underwent prostate magnetic resonance imaging and were found to have Prostate Imaging Reporting and Data System score ≥ 3 lesion(s). All 260 patients underwent standard 12-core biopsy and targeted biopsy during the same session. Clinically significant cancer was Gleason ≥3 + 4.

Results: Percentages of patients with prostate-specific antigen 0-1.99, 2-3.99, 4-4.99, 5-5.99, 6-9.99, and ≥10 were 3.0%, 4.7%, 20.8%, 16.9%, 37.7%, and 16.9%, respectively. Cumulative frequency of clinically significant prostate cancer increased with the addition of targeted biopsy compared with standard biopsy alone across all prostate-specific antigen ranges. The difference in clinically significant cancer detection between targeted plus standard biopsy compared to standard biopsy alone becomes statistically significant at prostate-specific antigen >4.3 (p=0.031). At this threshold, combination biopsy detected 20 clinically significant prostate cancers, while standard detected 14 with 88% sensitivity and 20% specificity. Excluding targeted biopsy in setting of a positive digital rectal exam would save 12.3% magnetic resonance imaging and miss 1.8% clinically significant cancers in our cohort.

Conclusions: In biopsy-naïve patients, at prostate-specific antigen >4.3, there is a significant increase in clinically significant prostate cancer detection when targeted biopsy is added to standard biopsy. Obtaining standard biopsy alone in patients with abnormal digital rectal examinations would miss 1.8% clinically significant cancers in our cohort.

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Biopsy-Naïve患者获得mri融合活检的最佳PSA阈值。
目的:本研究调查了在活检幼稚患者的标准12芯活检中添加靶向、基于软件的磁共振成像超声融合活检的前列腺特异性抗原阈值。其次探讨了在直肠指检异常的情况下是否有必要进行靶向活检。方法:对260例既往未经活检的疑似局限性前列腺癌症患者进行前列腺磁共振成像,发现前列腺成像报告和数据系统评分≥ 3处病变。在同一疗程中,所有260名患者均接受了标准的12核心活检和靶向活检。临床显著的癌症为Gleason≥3 + 4.结果:前列腺特异性抗原0-1.99、2-3.99、4-4.99、5-5.99、6-9.99和≥10的患者比例分别为3.0%、4.7%、20.8%、16.9%、37.7%和16.9%。在所有前列腺特异性抗原范围内,与单独的标准活检相比,随着靶向活检的增加,临床显著前列腺癌症的累积频率增加。当前列腺特异性抗原>4.3(p=0.031)时,靶向加标准活检与单独标准活检之间具有临床显著性的癌症检测差异在统计学上具有显著性。在此阈值下,联合活检检测到20种临床显著性前列腺癌,而标准活检检测到14种,灵敏度为88%,特异性为20%。在我们的队列中,在直肠指检呈阳性的情况下排除靶向活检将节省12.3%的磁共振成像,并遗漏1.8%的具有临床意义的癌症。结论:在生物病患者中,当前列腺特异性抗原>4.3时,当将靶向活检添加到标准活检中时,临床显著的前列腺癌症检测显著增加。在我们的队列中,仅对直肠指检异常的患者进行标准活检将错过1.8%的临床意义重大的癌症。
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来源期刊
Prostate Cancer
Prostate Cancer ONCOLOGY-
CiteScore
2.70
自引率
0.00%
发文量
9
审稿时长
13 weeks
期刊介绍: Prostate Cancer is a peer-reviewed, Open Access journal that provides a multidisciplinary platform for scientists, surgeons, oncologists and clinicians working on prostate cancer. The journal publishes original research articles, review articles, and clinical studies related to the diagnosis, surgery, radiotherapy, drug discovery and medical management of the disease.
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