ĐÁNH GIÁ CỘNG HƯỞNG TỪ LƯỠNG THAM SỐ TRƯỚC SINH THIẾT KẾT HỢP VỚI KHÁNG NGUYÊN ĐẶC HIỆU TỶ TRỌNG VÙNG CHUYỂN TIẾP TRONG VIỆC PHÁT HIỆN VÀ LOẠI TRỪ UNG THƯ VÙNG CHUYỂN TIẾP TUYẾN TIỀN LIỆT ĐIỂM GLEASON 7–10

Abstract

Purpose: To evaluate the diagnostic accuracy, predictive value and the best biopsy strategy combining bi-parametric magnetic resonance and prostate specific antigen density of transition zone (PSAdTZ) in detecting and excluding transition zone prostate cancer Gleason score of 7-10. Material and methods: Evaluation of 60 biopsied male patients with clinical suspicion of prostate cancer (high PSA or abnormal digital rectal) from February 2019 to May 2022. All patients underwent bi-parametric MRI (T2W and diffusion sequences), followed by systemic and targeted biopsies of suspected lesions in the prostate transition zone on MRI. Different bi-parametric MRI scores and PSAdTZ thresholds were evaluated using cancer Gleason score 7–10 detection rates, predictive value, and biopsy avoidance rates. Results: Transition zone prostate cancer was detected in 27/60 (accounting for 45%) of which 20/60 had Gleason score 7–10 (33%), and 33/60 lesions were non-cancerous (accounting for 55%). The median (interquartile range) for age, prostate transition volume, total PSA, transition zone PSA (PSAdTZ) were 66 years (62–70), 30.7 cc (17.2-40), 17.3 ng/ml (11.1–39.3) and 0.74 ng/ml/cc (0.27-2.1). With a bi-parametric MRI score ≤ 3, there were 27 patients, including 2 patients with Gleason score 7–10, and 24 patients without cancer (excess biopsies). Combining the bi-parametric MRI score ≤3 and PSAdTZ > 0.6 ng/ml/cc, there were only 10 patients in which 2 cancer with Gleason score of 7–10 but limited biopsies to 16 non-cancerous patients (only 8 patients with excessive biopsies). With a bi-parametric MRI score ≥ 4, there were 33 patients, including 18 lesions with Gleason score 7–10 and 9 lesions with non-cancerous (excess biopsies). Combining the bi-parametric MRI score ≥ 4 and PSAdTZ > 0.6 ng/ml/cc, there are 23 lesion including 17 lesions with Gleason score 7–10 (missing 1 cancer of this score) but only 4 lesions without cancer (reducing 5 cases of excessive biopsies). Thus, PSAdTZ significantly influenced the predictive values of bi-parametric MRI in the detection and exclusion of Gleason score of 7–10 transition zone prostate cancer. This reduces the number of men with unnecessary biopsies by 64% (21/33) while only missing 5% (1/20) men with a Gleason score of 7–10. Conclusions: The combination of bpMRI with PSAdTZ improves diagnostic accuracy and predictive value for cancer Gleason score of 7–10 detection rates in biopsy-naive male patients. Combining bi-parametric MRI results with PSAdTZ threshold > 0.6 ng/ml/cc was the best biopsy selection strategy in our study, effectively balancing risks and benefits.