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 naïve (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.
Falagario, U. G., Lantz, A., Jambor, I., Busetto, G. M., 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, A. B., Nordström, T., Björnebo, L., Oderda, M., Soria, F., Taimen, P., Aronen, H. J., Perez, I. M., 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., Boström, P. J., Messina, E., Panebianco, V., De Cobelli, O., Carrieri, G., Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors, <<WORLD JOURNAL OF UROLOGY>>, 2023; 41 (11): 2967-2974. [doi:10.1007/s00345-023-04634-2] [https://hdl.handle.net/10807/305200]
Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors
Totaro, Angelo;Racioppi, Marco;Manfredi, Matteo;Conti, Andrea;Bassi, Pierfrancesco;
2023
Abstract
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 naïve (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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