ĐÁNH GIÁ HỆ THỐNG PHÂN BẬC NGUY CƠ PHÁT TRIỂN RA NGOÀI CỦA UNG THƯ TUYẾN TIỀN LIỆT BẰNG CỘNG HƯỞNG TỪ ĐA THÔNG SỐ

Abstract

Purpose: To assess the risk of extra-prostatic extension (EPE) of prostate cancer (PCa) and propose a grading system based on multi-parametric magnetic resonance imaging (mp-MRI). Material and methods: Retrospective descriptive study on 32 male patients who visited Hanoi Medical University hospital from February 2019 to May 2022 due to high total PSA and/or urinary disorder. All patients underwent prostate mp-MRI, prostate transrectal ultrasound guided biopsies and histopathological results were prostate cancer. Using the MRI-based EPE grading system defined as follows: no contact to the capsule was grade 0, curvilinear length contact (curve measure) to the capsule of 15 mm or bulging and irregular capsule was grade 1, if presented both of the above features was grade 2, complete disruption of the capsule that invaded surrounding fat or adjacent anatomical structures was grade 3. Compared the grading system with Gleason score, total PSA and PSA density to assess the risk of EPE prostate cancer. Evaluate the correlation between the EPE grade with Gleason score. Results: A total of 32 prostate cancer patients, confirmed by histology results, in which 15 EPE of PCa on MRI. Median values (interquartile range) of age, total PSA, prostate volume, density PSA of the patient group were 65.5 (62.25-73.25), 31.8 ng/ml (14.6-57.9 ng/ml), 43 cc (30.75-51.75 cc) and 0.94 ng/ml/cc (0.36-1.5 ng/ml/cc), respectively. The classification results on mp-MRI showed that the number of EPE cancers of grade 0, level 1, level 2, and grade 3 were 17 (accounting for 53%), 05 (accounting for 15.7%), 03 (accounting for 9.4%) and 07 (accounting for 21.9%). Histopathological results showed among of 32 prostate cancers, the number of Gleason scores of 6, 7, 8 and 9 respectively 7, 14, 7 and 4. Out of 15 EPE cancers, the number of Gleason scores 6, 7, 8 and 9 are 3, 6, 4 and 2, respectively (accounting for 43%, 43%, 71.4% and 50% of cancers with corresponding cancer of Gleason scores, respectively). Compared with the grading system on MRI, all EPE cancers grade 2 and 3 had a Gleason score ≥7. Except for PSA density, there was the significant different between grade 1 and 3 with p < 0.05, the remaining parameters such as age, prostate volume, total PSA, PSA density did not have significant differences between steps (p>0.05). With the EPE cancer (grade ≥1), there was a strong correlation (r= 0.7, p=0.004) between Gleason score and the EPE grades. With Gleason score ≥7, the diagnostic performance (AUC) between grade 1 compared to level 2 and 3 was 0.92. Conclusion: The risk EPE of prostate cancer by mp- MRI grading system had high value and a strong correlation with Gleason score. The higher the Gleason score, the greater the risk of EPE prostate cancer.