摘要
前列腺癌(prostate cancer,PCa)是老年男性最常见的恶性肿瘤之一。早期前列腺癌通常无明显的临床症状,以前列腺特异性抗原(prostate-specific antigen,PSA)为基础的早期筛查被证实可以降低PCa的死亡率,但可能造成过度诊断和过度治疗等负面效应。近年来,经直肠超声(trans rectal ultra sound,TRUS)及多参数磁共振成像(multiparametric magnetic resonance imaging,mp-MRI)技术被越来越多地用于PCa的早期诊断及前列腺穿刺引导,但这些影像学技术在以人群为基础的前列腺癌筛查中的应用价值尚不明确。基于此,来自英国帝国理工大学的David等团队发起了一项前瞻性多中心的队列研究IP1-PROSTAGRAM,对比双参数核磁共振成像(biparametric magnetic resonance imaging,bpMRI)或超声弹性成像(shear wave elastography,SWE)与单纯PSA检测在前列腺癌人群筛查中的应用价值。该研究发现,相比于PSA≥3 ng/ml,以MRI PI-RADS 4~5分作为阳性阈值可以显著增加临床显著性前列腺癌(clinically significant prostate cancer,csPCa)的检出率,同时并不会增加前列腺穿刺人数和非csPCa (non-csPCa)的检出率。而超声相比于单纯PSA检测并没有表现出更好的预测价值。本文对IP1-PROSTAGRAM研究的方法、结果和意义进行解读。
Prostate Cancer(PCa) is one of the most common malignancies in elderly men.Early prostate cancer usually has no obvious clinical symptoms,and prostate-specific antigen(PSA) based early screening has been confirmed to reduce the mortality of PCa,but it may lead to overdiagnosis and overtreatment and other negative effects.In recent years,trans rectal ultra sound(TRUS) and multiparametric magnetic resonance imaging(mpMRI) technology has been increasingly used in the early diagnosis of PCa and the guidance of prostate puncture,but the application value of these imaging techniques in population-based prostate cancer screening remains unclear.Based on this,David et al.,from Imperial University London,UK,conducted a prospective multicenter cohort study,IP1-PROSTAGRAM study,to compare the biparametric magnetic resonance imaging(bpMRI) or shear wave elastography(SWE) versus PSA alone in prostate cancer screening.The results of this study found that,compared with PSA≥3 ng/ml,taking MRI score 4~5 as a positive threshold can significantly increase the detection rate of clinically significant prostate cancer(csPCa).Meanwhile,it does not increase the number of prostate punctures and the detection rate of non-csPCa.Compared with PSA alone,ultrasound did not show better predictive value.This paper will interpret the methods,results and significance of IP1-PROSTAGRAM study.
作者
崔玉双
曹煜东
王硕
杜鹏
Cui Yushuang;Cao Yudong;Wang Shuo;Du Peng(Department of Urology,Peking University Cancer Hospital,Beijing 100142,China)
出处
《泌尿外科杂志（电子版）》
2022年第4期20-23,共4页
Journal of Urology for Clinicians(Electronic Version)
基金
首都卫生发展科研专项项目(2022-1G-1021)
关键词
前列腺癌
筛查
前列腺特异性抗原
经直肠超声检查
磁共振成像
Prostate cancer
Screening
Prostate-specific antigen
Transrectal ultrasound examination
Magnetic resonance imaging
