A Prospective Multicenter Comparison Study of Risk-adapted Ultrasound-directed and Magnetic Resonance Imaging-directed Diagnostic Pathways for Suspected Prostate Cancer in Biopsy-naïve Men.

Autor: Wagensveld IM; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands., Osses DF; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands., Groenendijk PM; Department of Urology, Haaglanden Medical Center, The Hague, The Netherlands., Zijta FM; Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands., Busstra MB; Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Urology, Franciscus Gasthuis, Rotterdam, The Netherlands., Rociu E; Department of Radiology, Franciscus Gasthuis, Rotterdam, The Netherlands., Barentsz JO; Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands., Michiel Sedelaar JP; Department of Urology, Radboudumc, Nijmegen, The Netherlands., Arbeel B; Department of Urology, Flevoziekenhuis, Almere, The Netherlands., Roeleveld T; Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands., Geenen R; Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands., Koeter I; Department of Urology, Beatrix Ziekenhuis, Gorinchem, The Netherlands., van der Meer SA; Department of Urology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands., Cappendijk V; Department of Radiology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands., Somford R; Department of Urology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands., Klaver S; Department of Urology, Maasstad Ziekenhuis, Rotterdam, The Netherlands., Van der Lely H; Department of Radiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands., Wolters T; Department of Urology, Deventer Ziekenhuis, Deventer, The Netherlands., Hellings W; Department of Radiology, Deventer Ziekenhuis, Deventer, The Netherlands., Leter MR; Department of Urology, Dijklander Ziekenhuis, Hoorn, The Netherlands., Van der Poel HG; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Heijmink SWTPJ; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Debruyne F; Andros Clinics, Amsterdam, The Netherlands., Immerzeel J; Andros Clinics, Amsterdam, The Netherlands., Leijte J; Department of Urology, Amphia Ziekenhuis, Breda, The Netherlands., van Roermund J; Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands., Miclea R; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands., Planken E; Department of Urology, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands., Vis AN; Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Jan de Jong I; Department of Urology, Groningen University Medical Center, Groningen, The Netherlands., Tijsterman J; Department of Urology, Haga Ziekenhuis, The Hague, The Netherlands., Wolterbeek D; Department of Radiology, Haga Ziekenhuis, The Hague, The Netherlands., Claessen A; Department of Urology, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands., Vrijhof E; Department of Urology, Catharina Ziekenhuis, Eindhoven, The Netherlands., Nederend J; Department of Radiology, Catharina Ziekenhuis, Eindhoven, The Netherlands., Van Leenders GJLH; Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands., Bangma CH; Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Urology, Franciscus Gasthuis, Rotterdam, The Netherlands., Krestin GP; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands., Remmers S; Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands., Schoots IG; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: i.schoots@erasmusmc.nl.
Jazyk: angličtina
Zdroj: European urology [Eur Urol] 2022 Sep; Vol. 82 (3), pp. 318-326. Date of Electronic Publication: 2022 Mar 24.
DOI: 10.1016/j.eururo.2022.03.003
Abstrakt: Background: European Association of Urology guidelines recommend a risk-adjusted biopsy strategy for early detection of prostate cancer in biopsy-naïve men. It remains unclear which strategy is most effective. Therefore, we evaluated two risk assessment pathways commonly used in clinical practice.
Objective: To compare the diagnostic performance of a risk-based ultrasound (US)-directed pathway (Rotterdam Prostate Cancer Risk Calculator [RPCRC] #3; US volume assessment) and a magnetic resonance imaging (MRI)-directed pathway.
Design, Setting, and Participants: This was a prospective multicenter study (MR-PROPER) with 1:1 allocation among 21 centers (US arm in 11 centers, MRI arm in ten). Biopsy-naïve men with suspicion of prostate cancer (age ≥50 yr, prostate-specific antigen 3.0-50 ng/ml, ± abnormal digital rectal examination) were included.
Intervention: Biopsy-naïve men with elevated risk of prostate cancer, determined using RPCRC#3 in the US arm and Prostate Imaging Reporting and Data System scores of 3-5 in the MRI arm, underwent systematic biopsies (US arm) or targeted biopsies (MRI arm).
Outcome Measurements and Statistical Analysis: The primary outcome was the proportion of men with grade group (GG) ≥2 cancer. Secondary outcomes were the proportions of biopsies avoided and GG 1 cancers detected. Categorical (nonparametric) data were assessed using the Mann-Whitney U test and χ 2 tests.
Results and Limitations: A total of 1965 men were included in the intention-to-treat population (US arm n = 950, MRI arm n = 1015). The US and MRI pathways detected GG ≥2 cancers equally well (235/950, 25% vs 239/1015, 24%; difference 1.2%, 95% confidence interval [CI] -2.6% to 5.0%; p = 0.5). The US pathway detected more GG 1 cancers than the MRI pathway (121/950, 13% vs 84/1015, 8.3%; difference 4.5%, 95% CI 1.8-7.2%; p < 0.01). The US pathway avoided fewer biopsies than the MRI pathway (403/950, 42% vs 559/1015, 55%; difference -13%, 95% CI -17% to -8.3%; p < 0.01). Among men with elevated risk, more GG ≥2 cancers were detected in the MRI group than in the US group (52% vs 43%; difference 9.2%, 95% CI 3.0-15%; p < 0.01).
Conclusions: Risk-adapted US-directed and MRI-directed pathways detected GG ≥2 cancers equally well. The risk-adapted US-directed pathway performs well for prostate cancer diagnosis if prostate MRI capacity and expertise are not available. If prostate MRI availability is sufficient, risk assessment should preferably be performed using MRI, as this avoids more biopsies and detects fewer cases of GG 1 cancer.
Patient Summary: Among men with suspected prostate cancer, relevant cancers were equally well detected by risk-based pathways using either ultrasound or magnetic resonance imaging (MRI) to guide biopsy of the prostate. If prostate MRI availability is sufficient, risk assessment should be performed with MRI to reduce unnecessary biopsies and detect fewer irrelevant cancers.
(Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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