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.
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.