Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors

Falagario UG; Lantz A; Jambor I; Busetto GM; Bettocchi C; Finati M; Ricapito A; Luzzago S; Ferro M; Musi G; Totaro A; Racioppi M; Carbonara U; Checcucci E; Manfredi M; D'Aietti D; Porcaro AB; Nordström T; Björnebo L; Oderda M; Soria F; Taimen P; Aronen HJ; Perez IM; Ettala O; Marchioni M; Simone G; Ferriero M; Brassetti A; Napolitano L; Carmignani L; Signorini C; Conti A; Ludovico G; Scarcia M; Trombetta C; Claps F; Traunero F; Montanari E; Boeri L; Maggi M; Del Giudice F; Bove P; Forte V; Ficarra V; Rossanese M; Mucciardi G; Pagliarulo V; Tafuri A; Mirone V; Schips L; Antonelli A; Gontero P; Cormio L; Sciarra A; Porpiglia F; Bassi P; Ditonno P; Bostrom PJ; Messina E; Panebianco V; De Cobelli O; Carrieri G; PROMOD Study Grp
Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors

Falagario UG
Lantz A
Jambor I
Busetto GM
Bettocchi C
Finati M
Ricapito A
Luzzago S
Ferro M
Musi G
Totaro A
Racioppi M
Carbonara U
Checcucci E
Manfredi M
D'Aietti D
Porcaro AB
Nordström T
Björnebo L
Oderda M
Soria F
Taimen P
Aronen HJ
Perez IM
Ettala O
Marchioni M
Simone G
Ferriero M
Brassetti A
Napolitano L
Carmignani L
Signorini C
Conti A
Ludovico G
Scarcia M
Trombetta C
Claps F
Traunero F
Montanari E
Boeri L
Maggi M
Del Giudice F
Bove P
Forte V
Ficarra V
Rossanese M
Mucciardi G
Pagliarulo V
Tafuri A
Mirone V
Schips L
Antonelli A
Gontero P
Cormio L
Sciarra A
Porpiglia F
Bassi P
Ditonno P
Bostrom PJ
Messina E
Panebianco V
De Cobelli O
Carrieri G
PROMOD Study Grp
Katso/Avaa
Lataukset: 

SPRINGER
doi:10.1007/s00345-023-04634-2
URI
https://doi.org/10.1007/s00345-023-04634-2
Näytä kaikki kuvailutiedot
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2025082786086
Tiivistelmä

Purpose The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade >= 2).

Methods This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients.

Results 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naive (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG >= 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS >= 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively.

Conclusions Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions.

Trial registration The present study was registered at ClinicalTrials.gov number: NCT05078359.

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