The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men  

作　　者：Peter KF Chiu Thomas YT Lam Chi-Fai Ng Jeremy YC Teoh Carmen CM Cho Hiu-Yee Hung Cindy Hong Monique J Roobol Winnie CW Chu Samuel YS Wong Joseph JY Sung 

机构地区：[1]SH Ho Urology Centre,Department of Surgery,The Chinese University of Hong Kong,Hong Kong SAR,China [2]The Jockey Club School of Public Health and Primary Care,The Chinese University of Hong Kong,Hong Kong SAR,China [3]Department of Imaging and Interventional Radiology,The Chinese University of Hong Kong,Hong Kong SAR,China [4]Erasmus MC Cancer Institute,Erasmus Medical University,Rotterdam 3015,The Netherlands [5]Lee Kong Chian School of Medicine,Nanyang Technological University,Singapore 308232,Singapore

出　　处：《Asian Journal of Andrology》2023年第6期674-679,共6页亚洲男性学杂志（英文版）

基　　金：This study is fully funded by the Hong Kong Jockey Club Charities Trust(Ref No.2018/0043).

摘　　要：Using prostate-specific antigen(PSA)for prostate cancer(PCa)screening led to overinvestigation and overdiagnosis of indolent PCa.We aimed to investigate the value of prostate health index(PHI)and magnetic resonance imaging(MRI)prostate in an Asian PCa screening program.Men aged 50–75 years were prospectively recruited from a community-based PSA screening program.Men with PSA 4.0–10.0 ng ml^(−1) had PHI result analyzed.MRI prostate was offered to men with PSA 4.0–50.0 ng ml−1.A systematic prostate biopsy was offered to men with PSA 4.0–9.9 ng ml^(−1) and PHI≥35,or PSA 10.0–50.0 ng ml^(−1).Additional targeted prostate biopsy was offered if they had PI-RADS score≥3.Clinically significant PCa(csPCa)was defined as the International Society of Urological Pathology(ISUP)grade group(GG)≥2 or ISUP GG 1 with involvement of≥30%of total systematic cores.In total,12.8%(196/1536)men had PSA≥4.0 ng ml^(−1).Among 194 men with PSA 4.0–50.0 ng ml^(−1),187(96.4%)received MRI prostate.Among them,28.3%(53/187)had PI-RADS≥3 lesions.Moreover,7.0%(107/1536)men were indicated for biopsy and 94.4%(101/107)men received biopsy.Among the men received biopsy,PCa,ISUP GG≥2 PCa,and csPCa was diagnosed in 42(41.6%),24(23.8%),and 34(33.7%)men,respectively.Compared with PSA/PHI pathway in men with PSA 4.0–50.0 ng ml^(−1),additional MRI increased diagnoses of PCa,ISUP GG≥2 PCa,and csPCa by 21.2%(from 33 to 40),22.2%(from 18 to 22),and 18.5%(from 27 to 32),respectively.The benefit of additional MRI was only observed in PSA 4.0–10.0 ng ml^(−1),and the number of MRI needed to diagnose one additional ISUP GG≥2 PCa was 20 in PHI≥35 and 94 in PHI<35.Among them,45.4%(89/196)men with PSA≥4.0 ng ml^(−1) avoided unnecessary biopsy with the use of PHI and MRI.A screening algorithm with PSA,PHI,and MRI could effectively diagnose csPCa while reducing unnecessary biopsies.The benefit of MRI prostate was mainly observed in PSA 4.0–9.9 ng ml^(−1) and PHI≥35 group.PHI was an important risk stratification

关 键 词：magnetic resonance imaging prostate prostate cancer prostate health index prostate-specific antigen SCREENING 

分 类 号：R737.25[医药卫生—肿瘤]