目的:本研究旨在研究临床和放射学参数在检测具有前列腺影像报告和数据系统3病变的患者中具有临床意义的前列腺癌中的预期能力。
方法:这是一项回顾性研究。这项研究包括来自苏州大学附属第一医院的453名患者,2017年9月至2022年8月之间的采样。每位患者均接受常规12核前列腺活检,然后进行2至5核融合靶向活检。我们利用单变量和多变量逻辑回归分析来确定与临床上有意义的前列腺癌相关的参数。使用受试者工作特性曲线评估这些参数的预测能力,导致创建列线图。
结果:在453例前列腺影像报告和数据系统3病变患者中,有68例检测到有临床意义的前列腺癌(15.01%)。在前列腺影像报告和数据系统3a和3b患者中,4.78%(占总数的3.09%)和33.75%(占总数的11.92%),分别,有临床意义的前列腺癌。系统活检提高了前列腺癌和临床意义前列腺癌的检出率7.72%和3.09%,分别,与靶向活检相比。没有系统活检,在前列腺成像报告和数据系统3b患者中,前列腺癌的未被发现率为15%,有临床意义的前列腺癌的未被发现率为8.13%.几个临床参数,包括年龄,前列腺特异性抗原密度,病变体积,表观扩散系数,直肠指检,在具有临床意义的前列腺癌的逻辑回归分析中具有统计学意义。这些参数对有临床意义的前列腺癌的个体诊断准确性分别为0.648、0.645、0.75、0.763和0.7。但他们的综合精度提高到0.866。根据已识别的风险因素构建了拟合良好的列线图(χ2=10.254,P=0.248)。
结论:年龄的组合,前列腺特异性抗原密度,病变体积,表观扩散系数,在前列腺影像报告和数据系统3病变的患者中,直肠指检对有临床意义的前列腺癌的诊断价值高于任何单一参数。系统活检被证明对于患有前列腺影像学报告和数据系统3病变的未接受活检的患者至关重要,不应被忽略。
OBJECTIVE: This study intends to examine the anticipatory power of clinical and radiological parameters in detecting clinically significant prostate cancer in patients demonstrating Prostate Imaging Reporting and Data System 3 lesions.
METHODS: This was a retrospective study. The study included participation from 453 patients at the First Affiliated Hospital of Soochow University, sampled between September 2017 through August 2022. Each patient underwent a routine 12-core prostate biopsy followed by a 2 to 5 core fusion-targeted biopsy. We utilized both univariate and multivariate logistic regression analyses to identify the parameters that have a correlation with clinically significant prostate cancer. The predictive ability of these parameters was assessed using the receiver operating characteristic curve, leading to the creation of a nomogram.
RESULTS: Clinically significant prostate cancer was detected in 68 out of 453 patients with Prostate Imaging Reporting and Data System 3 lesions (15.01%). Among Prostate Imaging Reporting and Data System 3a and 3b patients, 4.78% (3.09% of the total) and 33.75% (11.92% of the total), respectively, had clinically significant prostate cancer. Systematic biopsy improved prostate cancer and clinically significant prostate cancer detection rates by 7.72% and 3.09%, respectively, compared to targeted biopsy. Without systematic biopsy, there would be an undetected rate of 15% for prostate cancer and 8.13% for clinically significant prostate cancer in Prostate Imaging Reporting and Data System 3b patients. Several clinical parameters, including age, prostate-specific antigen density, lesion volume, apparent diffusion coefficient, and digital rectal examination, were statistically significant in the logistic regression analysis for clinically significant prostate cancer. The individual diagnostic accuracies of these parameters for clinically significant prostate cancer were 0.648, 0.645, 0.75, 0.763, and 0.7, respectively, but their combined accuracy improved to 0.866. A well-fit nomogram based on the identified risk factors was constructed (χ2 = 10.254, P = .248).
CONCLUSIONS: The combination of age, prostate-specific antigen density, lesion volume, apparent diffusion coefficient, and digital rectal examination presented a higher diagnostic value for clinically significant prostate cancer than any single parameter in patients with Prostate Imaging Reporting and Data System 3 lesions. Systematic biopsy proved crucial for biopsy-naive patients with Prostate Imaging Reporting and Data System 3 lesions and should not be omitted.