Prostat Görüntüleme Raporlama ve Veri Sistemi-3 lezyonlarında prostat kanserini öngören temel faktörler

Year 2021, Volume: 16 Issue: 2, 184 - 189, 29.06.2021

Sercan Yilmaz , Mehmet Yılmaz , Serdar Yalçın , Engin Kaya , Eymen Gazel , Halil Çağrı Aybal , Hakan Özdemir Mehmet Yorubulut Ali Oner Lütfi Tunç

https://doi.org/10.33719/yud.2021;16-2-850090

Abstract

Amaç: Bu çalışmada Prostat Görüntüleme ve Veri Raporlama Sistemi (PI-RADS) 3 lezyonlarında prostat kanserini öngörmede dijital rektal muayene ile PSA dansitesi, lezyonun bölgesel konumu ve prostat boyutunun rolünü araştırmak istedik.

Gereç ve Yöntemler: PSA düzeyi yükselmiş ve / veya dijital rektal muayenesi şüpheli olması nedeniyle multiparametrik MR çekilmiş ve biyopsi sonucu PI-RADS 3 olarak raporlanmış toplam 236 hastanın verileri retrospektif olarak incelendi. Prostat kanseri tespit oranı, dijital rektal muayene bulguları, lezyonların yeri, PSA dansite sonuçları, prostat hacmi sonuçları ve alt grup analizleri ile risk sınıflandırılması yapıldı.

Bulgular: PI-RADS Skoru 3 olan 137 hasta çalışmaya dahil edildi. Genel prostat kanseri tespit oranı % 26,2 ve klinik önemli prostat kanseri tespit oranı % 4,3’tü. Dijital rektal muayene bulguları (p = 0,001) ve lezyonun periferik zon yerleşimi (p = 0,005) ile prostat kanseri olmayan gruplar arasında anlamlı farklılık bulundu. Dijital rektal muayene (p = 0.001), çok değişkenli lojistik regresyon analizinde PIRADS-3 lezyonlu hastalarda prostat kanserinin bağımsız prediktörü olarak tespit edildi.

Sonuç: Dijital rektal muayene, PI-RADS 3 lezyonu olan hastalarda prostat kanseri şüphesini ortaya koymak açısından pratik ve önemli bir parametredir.

Keywords

prostat kanseri , dijital rektal muayene , magnetik rezonans görüntüleme

Basic factors predicting prostate cancer in Prostate Imaging Reporting and Data System-3 lesions

Abstract

Objective: We aimed to investigate the role of the digital rectal examination, PSA density, regional location of the lesion and prostate size in predicting prostate cancer in Prostate Imaging and Data Reporting System (PI-RADS)-3 lesions.

Material and Methods: A total of 236 patients with multiparametric MRI performed for clinical suspicion of prostate cancer and reported PI-RADS-3 enrolled between January 2016 and July 2019 in this retrospective study. The datas were extracted from the hospital’s electronic records, patient files and outpatient clinic records. Multiparametric MRI was performed patients to whom have elevated PSA level and/or suspicious digital rectal examination. Patients diagnosed with and without prostate cancer were compared in terms of age, PSA, PSA density, prostate size, pathological results, lesion localization and DRE findings.

Results: One hundred thirty- independent predictor seven patients with an initial score of PI-RADS-3 were subjected to further analysis. Prostat cancer detection rate in overall and clinically significant prostate cancer detection rate was 26.2% and 4.3%, respectively. There was a significant difference regarding DRE findings (p=0.001) and PZ location of the lesion (p=0.005) between PCa and no PCa groups. Digital rectal examination (p=0.001) was an independent predictor of prostate cancer in multivariate logistic regression analysis.

Conclusion: Digital rectal examination is a practical and important parameter in clarifying the suspicion of prostate cancer in PI-RADS-3 lesions.

Keywords

prostatic neoplasms , digital rectal examination , multiparametric magnetic resonance imaging , image guided biopsy

References

• 1. Center MM, Jemal A, Lortet-Tieulent J, et al. International variation in prostate cancer incidence and mortality rates. Eur Urol. 2012;61:1079-92. DOI:10.1016/j.eururo.2012.02.054.
• 2. Trabulsi EJ HE, Gomella LG. Ultrasonography and biopsy of the prostate. 10 ed. Philadelphia: Saunders; 2011 2011. 2735-47 p.
• 3. Pinkhasov GI, Lin YK, Palmerola R, et al. Complications following prostate needle biopsy requiring hospital admission or emergency department visits - experience from 1000 consecutive cases. BJU Int. 2012;110:369-74. DOI:10.1111/j.1464-410X.2011.10926.x.
• 4. Scheenen TW, Rosenkrantz AB, Haider MA, Futterer JJ. Multiparametric Magnetic Resonance Imaging in Prostate Cancer Management: Current Status and Future Perspectives. Invest Radiol. 2015;50:594-600. DOI:10.1097/rli.0000000000000163.
• 5. Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol. 2012;22:746-57. DOI:10.1007/s00330-011-2377-y.
• 6. Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016;69:16-40. DOI:10.1016/j.eururo.2015.08.052.
• 7. Carroll PR, Parsons JK, Andriole G, et al. NCCN Guidelines Insights: Prostate Cancer Early Detection, Version 2.2016. J Natl Compr Canc Netw. 2016;14:509-19. DOI:10.6004/jnccn.2016.0060.
• 8. Dickinson L, Ahmed HU, Allen C, et al. Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol. 2011;59:477-94. DOI:10.1016/j.eururo.2010.12.009.
• 9. Epstein JI, Egevad L, Amin MB, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016;40:244-52. DOI:10.1097/pas.0000000000000530.
• 10. Moore CM, Kasivisvanathan V, Eggener S, et al. Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol. 2013;64:544-52. DOI:10.1016/j.eururo.2013.03.030.
• 11. Bul M, Zhu X, Valdagni R, et al. Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol. 2013;63:597-603. DOI:10.1016/j.eururo.2012.11.005.
• 12. Washino S, Okochi T, Saito K, et al. Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naive patients. BJU Int. 2017;119:225-33. DOI:10.1111/bju.13465.
• 13. Hansen NL, Kesch C, Barrett T, et al. Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. BJU Int. 2017;120:631-8. DOI:10.1111/bju.13711.
• 14. Kim TJ, Lee MS, Hwang SI, Lee HJ, Hong SK. Outcomes of magnetic resonance imaging fusion-targeted biopsy of prostate imaging reporting and data system 3 lesions. World J Urol. 2019;37:1581-6. DOI:10.1007/s00345-018-2565-3.
• 15. Cuocolo R, Stanzione A, Rusconi G, et al. PSA-density does not improve bi-parametric prostate MR detection of prostate cancer in a biopsy naive patient population. Eur J Radiol. 2018;104:64-70. DOI:10.1016/j.ejrad.2018.05.004.
• 16. Ullrich T, Quentin M, Arsov C, et al. Risk Stratification of Equivocal Lesions on Multiparametric Magnetic Resonance Imaging of the Prostate. J Urol. 2018;199:691-8. DOI:10.1016/j.juro.2017.09.074.
• 17. Brizmohun Appayya M, Sidhu HS, Dikaios N, et al. Characterizing indeterminate (Likert-score 3/5) peripheral zone prostate lesions with PSA density, PI-RADS scoring and qualitative descriptors on multiparametric MRI. Br J Radiol. 2018;91:20170645. DOI:10.1259/bjr.20170645.
• 18. Gortz M, Radtke JP, Hatiboglu G, et al. The Value of Prostate-specific Antigen Density for Prostate Imaging-Reporting and Data System 3 Lesions on Multiparametric Magnetic Resonance Imaging: A Strategy to Avoid Unnecessary Prostate Biopsies. Eur Urol Focus. 2021;7:325-31. DOI:10.1016/j.euf.2019.11.012.
• 19. Ryoo H, Kang MY, Sung HH, et al. Detection of prostate cancer using prostate imaging reporting and data system score and prostate-specific antigen density in biopsy-naive and prior biopsy-negative patients. Prostate Int. 2020;8:125-9. DOI:10.1016/j.prnil.2020.03.003.
• 20. Hermie I, Van Besien J, De Visschere P, Lumen N, Decaestecker K. Which clinical and radiological characteristics can predict clinically significant prostate cancer in PI-RADS 3 lesions? A retrospective study in a high-volume academic center. Eur J Radiol. 2019;114:92-8. DOI:10.1016/j.ejrad.2019.02.031.
• 21. Di Trapani E, Musi G, Ferro M, et al. Clinical evaluation and disease management of PI-RADS 3 lesions. Analysis from a single tertiary high-volume center. Scand J Urol. 2020:1-5. DOI:10.1080/21681805.2020.1798503.
• 22. Omri N, Alex S, Jacob B, Ofer N. The additive value of mpMRI on prostate cancer detection: Comparison between patients with and without a suspicious digital rectal examination (DRE). Urol Oncol. 2021. DOI:10.1016/j.urolonc.2020.12.029.