Background

It has been suggested that targeting prostate lesions identified on magnetic resonance imaging (MRI) will improve the sensitivity of prostate biopsy for high-grade disease. The clinical significance of high-grade tumors found on MRI but missed on systematic biopsy is open to question.

Objective

To determine the risk of mortality for high-grade cancers identified by MRI targeting in men who had benign systematic biopsy findings.

Design, setting, and participants

We used data from 999 men with negative systematic biopsy and concurrent MRI-targeted biopsy in the National Cancer Institute MRI study. The comparison group consisted of 3056 men followed for 11 yr after negative sextant biopsy in the European Randomized Trial of Screening for Prostate Cancer (ERSPC).

Outcome measurements and statistical analysis

We calculated the number of patients needed to be diagnosed (NND) and treated (NNT) following targeted biopsy in order to prevent one prostate cancer death at 11 yr. We used a simple modeling approach that involved several assumptions, such as the proportion of the deaths in ERSPC preventable by earlier detection with MRI-guided biopsy. We then varied these assumptions to assess the effects on the results.

Results and limitations

NND and NNT were 89 and 57 for the scenario involving assumptions favorable to MRI, and 169 and 127 for a more neutral set of assumptions, respectively. Results were only more encouraging for MRI targeting under unlikely scenarios, such as 100% sensitivity for MRI and a cure rate of 100% for treatment.

Conclusions

Although MRI may be of benefit overall, considering the decrease in overdiagnosis among men with negative MRI findings, targeting biopsy needles to MRI-detected lesions results in a large number of men diagnosed and treated per death prevented. Consideration should be given to changing guidelines on grading of MRI cores and those regarding treatment of MRI-detected high-grade prostate cancer.

Patient summary

We carried out a modeling study to assess how magnetic resonance imaging (MRI) scan results used to target prostate cancer lesions during biopsy can affect outcomes. The model results show that if MRI-visible tumors are targeted during prostate biopsy, a large number of men need to be diagnosed and treated for prostate cancer in order to avoid just one prostate cancer death.

中文翻译：

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磁共振成像靶向对前列腺癌过度诊断和过度治疗的影响

背景

有人建议，针对磁共振成像 (MRI) 上确定的前列腺病变将提高前列腺活检对高级别疾病的敏感性。在 MRI 上发现但在系统活检中遗漏的高级别肿瘤的临床意义值得商榷。

客观的

确定具有良性系统活检结果的男性通过 MRI 靶向识别的高级别癌症的死亡率风险。

设计、设置和参与者

在国家癌症研究所 MRI 研究中，我们使用了来自 999 名系统活检阴性且同时进行 MRI 靶向活检的男性的数据。比较组由 3056 名在欧洲前列腺癌筛查随机试验 (ERSPC) 中六分仪活检阴性后随访 11 年的男性组成。

结果测量和统计分析

我们计算了靶向活检后需要诊断 (NND) 和治疗 (NNT) 的患者数量，以防止在 11 年时出现 1 例前列腺癌死亡。我们使用了一种简单的建模方法，该方法涉及多个假设，例如 ERSPC 中死亡的比例可以通过 MRI 引导的活检早期检测来预防。然后我们改变这些假设以评估对结果的影响。

结果和局限性

对于涉及有利于 MRI 的假设的情景，NND 和 NNT 分别为 89 和 57，而对于一组更中性的假设，分别为 169 和 127。在不太可能的情况下，例如 MRI 的灵敏度为 100%，治疗的治愈率为 100%，结果只会更令人鼓舞。

结论

尽管 MRI 总体上可能是有益的，但考虑到 MRI 结果为阴性的男性过度诊断的减少，将活检针定位到 MRI 检测到的病变会导致大量男性被诊断和治疗，从而避免死亡。应考虑改变有关 MRI 核心分级的指南以及有关 MRI 检测到的高级别前列腺癌治疗的指南。

患者总结

我们进行了一项建模研究，以评估活检期间用于靶向前列腺癌病变的磁共振成像 (MRI) 扫描结果如何影响结果。模型结果表明，如果在前列腺活检期间以 MRI 可见肿瘤为目标，则需要对大量男性进行前列腺癌诊断和治疗，以避免仅有一例前列腺癌死亡。