Abstract：
OBJECTIVE: To evaluate the interaction of patient age and Prostate Imaging-Reporting and Data System (PI-RADS) score in determining the grade of prostate cancer (PCa) identified on magnetic resonance imaging (MRI)-targeted biopsy in older men.
METHODS: From a prospectively accrued Institutional Review Board-approved comparative study of MRI-targeted and systematic biopsy between June 2012 and December 2022, men with at least one PI-RADS ≥3 lesion on pre-biopsy MRI and no prior history of PCa were selected. Ordinal and binomial logistic regression analyses were performed.
RESULTS: A total of 2677 men met study criteria. The highest PI-RADS score was 3 in 1220 men (46%), 4 in 950 men (36%), and 5 in 507 men (19%). The median (interquartile range [IQR]) patient age was 66.7 (60.8-71.8) years, median (IQR) prostate-specific antigen (PSA) level was 6.1 (4.6-9.0) ng/mL, median (IQR) prostate volume was 48 (34-68) mL, and median (IQR) PSA density was 0.13 (0.08-0.20) ng/mL/mL. Clinically significant (cs)PCa and high-risk PCa were identified on targeted biopsy in 1264 (47%) and 321 (12%) men, respectively. Prevalence of csPCa and high-risk PCa were significantly higher in the older age groups. On multivariable analyses, patient age was significantly associated with csPCa but not high-risk PCa; PI-RADS score and the interaction of age and PI-RADS score were significantly associated with high-risk PCa but not csPCa.
CONCLUSIONS: In our cohort, the substantial rate of high-risk PCa on MRI-ultrasound fusion targeted biopsies in older men, and its significant association with MRI findings, supports the value of pre-biopsy MRI to localise disease that could cause cancer mortality even in older men.
METHODS: From a prospectively accrued Institutional Review Board-approved comparative study of MRI-targeted and systematic biopsy between June 2012 and December 2022, men with at least one PI-RADS ≥3 lesion on pre-biopsy MRI and no prior history of PCa were selected. Ordinal and binomial logistic regression analyses were performed.
RESULTS: A total of 2677 men met study criteria. The highest PI-RADS score was 3 in 1220 men (46%), 4 in 950 men (36%), and 5 in 507 men (19%). The median (interquartile range [IQR]) patient age was 66.7 (60.8-71.8) years, median (IQR) prostate-specific antigen (PSA) level was 6.1 (4.6-9.0) ng/mL, median (IQR) prostate volume was 48 (34-68) mL, and median (IQR) PSA density was 0.13 (0.08-0.20) ng/mL/mL. Clinically significant (cs)PCa and high-risk PCa were identified on targeted biopsy in 1264 (47%) and 321 (12%) men, respectively. Prevalence of csPCa and high-risk PCa were significantly higher in the older age groups. On multivariable analyses, patient age was significantly associated with csPCa but not high-risk PCa; PI-RADS score and the interaction of age and PI-RADS score were significantly associated with high-risk PCa but not csPCa.
CONCLUSIONS: In our cohort, the substantial rate of high-risk PCa on MRI-ultrasound fusion targeted biopsies in older men, and its significant association with MRI findings, supports the value of pre-biopsy MRI to localise disease that could cause cancer mortality even in older men.
摘要：
目的：评估患者年龄和前列腺成像报告和数据系统（PI-RADS）评分在确定磁共振成像（MRI）靶向活检确定的老年男性前列腺癌（PCa）分级中的相互作用。
方法：从2012年6月至2022年12月的一项前瞻性机构审查委员会批准的MRI靶向和系统活检的比较研究中，选择了在活检前MRI上至少有一个PI-RADS≥3个病灶且无PCa病史的男性。进行序数和二项逻辑回归分析。
结果：共有2677名男性符合研究标准。最高的PI-RADS评分是1220名男性中的3分（46%），950人中有4人（36%），507人中有5人(19%)。中位（四分位距[IQR]）患者年龄为66.7（60.8-71.8）岁，中位（IQR）前列腺特异性抗原（PSA）水平为6.1（4.6-9.0）ng/mL，前列腺体积中位数（IQR）为48（34-68）mL，PSA密度中位数（IQR）为0.13（0.08-0.20）ng/mL/mL。在1264（47％）和321（12％）男性的靶向活检中发现了临床上有意义的（cs）PCa和高危PCa，分别。CSPCa和高危PCa的患病率在老年组中明显更高。在多变量分析中，患者年龄与csPCa显著相关,但与高危PCa无关;PI-RADS评分以及年龄和PI-RADS评分的交互作用与高危PCa显著相关,但与csPCa无关.
结论：在我们的队列中，在老年男性中，MRI-超声融合靶向活检的高危PCa发生率较高，以及它与MRI发现的显著关联，支持活检前MRI定位即使在老年男性中也可能导致癌症死亡的疾病的价值.
方法：从2012年6月至2022年12月的一项前瞻性机构审查委员会批准的MRI靶向和系统活检的比较研究中，选择了在活检前MRI上至少有一个PI-RADS≥3个病灶且无PCa病史的男性。进行序数和二项逻辑回归分析。
结果：共有2677名男性符合研究标准。最高的PI-RADS评分是1220名男性中的3分（46%），950人中有4人（36%），507人中有5人(19%)。中位（四分位距[IQR]）患者年龄为66.7（60.8-71.8）岁，中位（IQR）前列腺特异性抗原（PSA）水平为6.1（4.6-9.0）ng/mL，前列腺体积中位数（IQR）为48（34-68）mL，PSA密度中位数（IQR）为0.13（0.08-0.20）ng/mL/mL。在1264（47％）和321（12％）男性的靶向活检中发现了临床上有意义的（cs）PCa和高危PCa，分别。CSPCa和高危PCa的患病率在老年组中明显更高。在多变量分析中，患者年龄与csPCa显著相关,但与高危PCa无关;PI-RADS评分以及年龄和PI-RADS评分的交互作用与高危PCa显著相关,但与csPCa无关.
结论：在我们的队列中，在老年男性中，MRI-超声融合靶向活检的高危PCa发生率较高，以及它与MRI发现的显著关联，支持活检前MRI定位即使在老年男性中也可能导致癌症死亡的疾病的价值.
