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前列腺癌查的初级非对比磁共振成像:一个随机临床试验 (PROSA)

Emanuele Messina¹, Antonella Borrelli¹, Alessandro Sciarra²

¹Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University, Rome, Italy.

European urology

|December 18, 2025

概括

与标准PSA检测相比,一种新的MRI-first查策略显著改善了临床显著前列腺癌 (csPCa) 的检测. 这种方法为前列腺癌查提供了更好的益害指标和成本效益.

科学领域:

泌尿器科泌尿器科泌尿器科泌尿器科
放射学放射学是一门学科.
在瘤学瘤学.

背景情况:

前列腺特异性抗原 (PSA) 查前列腺癌 (PCa) 的精度有限,导致过度诊断.
目前的查方法需要改进,以检测临床显著的PCa (csPCa).

研究的目的:

评估一种没有对比的双参数MRI (bpMRI) - - 首次查策略来检测csPCa.
评估二次结果,包括整体PCa检测,益处-危害指标和成本效益.

主要方法:

一个单中心随机对照试验,涉及816名49-69岁无症状男性.
两只手臂:A手臂 (bpMRI不考虑PSA),B手臂 (bpMRI仅在PSA≥3ng/ml或2.5ng/ml与家族病史的情况下).
对前列腺成像报告和数据系统得分≥3的男性进行向活检;csPCa定义为国际泌尿病学学会等级组≥2.2.

主要成果:

与标准手臂相比,MRI-first手臂的csPCa检测率较高 (4.6%),相对风险为2.6 (p=0.05).
在MRI-first策略中改善了益害指标,包括更高等级的选择性和活检避免.
该MRI-first策略显示,每个发现的csPCa病例的增量成本效益比为2201.75欧元.

结论:

一个无对比度的MRI-first路径显著提高了临床上显著的前列腺癌的检测.
这一策略改善了益害指标,并在前列腺癌查中证明了有利的成本效益.
这些发现支持在前列腺癌查方案中实施MRI-first方法.

关键词:

卫生技术评估卫生技术评估磁共振成像技术磁共振成像技术前列腺癌是什么意思前列腺癌是什么意思查检查查检查查检查

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