前列腺癌根治性前列腺切除术后复发患者放射治疗前psa水平和病理状态预测mp-MRI结果的作用

D. Santucci , D. Vertulli , F. Esperto , L. Eolo Trodella , S. Ramella , R. Papalia , R.M. Scarpa , C. de Felice , R. Francesco Grasso , B. Beomonte Zobel , E. Faiella
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Considering Gleason Score (GS), pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before RT were performed in order to identify the optimal cut-off to predict mp-MRI result.</p></div><div><h3>Results</h3><p>Group A and B showed higher AUC for PSA before RT than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best AUC was 0.646 and 0.685 in group A and B; for high grade the best AUC was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565−0.58<!--> <!-->ng/mL in group A (sensitivity, specificity: 70.5%, 66%), and 0.11−0.13<!--> <!-->ng/mL in B (sensitivity, specificity: 62.5%, 84.6%). 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引用次数: 0

摘要

目的:评价PSA在mp-MRI结果预测中的价值,分析高分级(GS≥8,pT≥3,pN1)和低分级(GS)患者。材料和方法:188例患者在根治性前列腺切除术(RP)后和放疗(RT)前行1.5 tmp - mri检查。将有生化复发(BCR)和无BCR但局部复发风险高的患者分为A、B两组。将Gleason Score (GS)、pT和pN作为独立分组变量,对原发性PCa诊断时的PSA水平和RT前的PSA水平进行ROC分析,以确定预测mp-MRI结果的最佳截止点。结果:A组和B组在低分级和高分级肿瘤中,RT前PSA AUC均高于PCa诊断时PSA AUC。对于低分级肿瘤,A、B组最佳AUC分别为0.646、0.685;高分级A、B组最佳AUC分别为0.705和1。对于低级别肿瘤,A组最佳PSA临界值为0.565-0.58 ng/ml(敏感性,特异性:70.5%,66%),B组最佳PSA临界值为0.11-0.13 ng/ml(敏感性,特异性:62.5%,84.6%)。对于高级别肿瘤,A组获得的最佳PSA截止值为0.265-0.305 ng/ml(灵敏度,特异性:95%,42.1%),B组为0.13-0.15 ng/ml(灵敏度,特异性:100%)。结论:当检测到BCR时,Mp-MRI应作为附加诊断工具,特别是在高级别PCa中。对于无BCR的患者,mp-MRI结果虽然与病理状态相关性较差,但仍有较好的诊断价值,多在PSA > 0.1 ~ 0.15 ng/ml时。
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Role of psa levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy

Objective

To evaluate PSA value in mp-MRI results prediction, analyzing patients with high (GS  8, pT  3, pN1) and low grade (GS < 8, pT < 3, pN0) Prostate Cancer (PCa).

Materials and methods

One hundred eighty-eight patients underwent 1.5-Tmp-MRI after Radical Prostatectomy (RP) and before Radiotherapy (RT). They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score (GS), pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before RT were performed in order to identify the optimal cut-off to predict mp-MRI result.

Results

Group A and B showed higher AUC for PSA before RT than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best AUC was 0.646 and 0.685 in group A and B; for high grade the best AUC was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565−0.58 ng/mL in group A (sensitivity, specificity: 70.5%, 66%), and 0.11−0.13 ng/mL in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265−0.305 ng/mL in group A (sensitivity, specificity: 95%, 42.1%), and 0.13−0.15 ng/mL in B (sensitivity, specificity: 100%).

Conclusion

Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA > 0.1−0.15 ng/mL.

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