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.

Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors / Falagario, Ugo G; Lantz, Anna; Jambor, Ivan; Busetto, Gian Maria; Bettocchi, Carlo; Finati, Marco; Ricapito, Anna; Luzzago, Stefano; Ferro, Matteo; Musi, Gennaro; Totaro, Angelo; Racioppi, Marco; Carbonara, Umberto; Checcucci, Enrico; Manfredi, Matteo; D'Aietti, Damiano; Porcaro, Antonio Benito; Nordström, Tobias; Björnebo, Lars; Oderda, Marco; Soria, Francesco; Taimen, Pekka; Aronen, Hannu J; Perez, Ileana Montoya; Ettala, Otto; Marchioni, Michele; Simone, Giuseppe; Ferriero, Mariaconsiglia; Brassetti, Aldo; Napolitano, Luigi; Carmignani, Luca; Signorini, Claudia; Conti, Andrea; Ludovico, Giuseppe; Scarcia, Marcello; Trombetta, Carlo; Claps, Francesco; Traunero, Fabio; Montanari, Emanuele; Boeri, Luca; Maggi, Martina; Del Giudice, Francesco; Bove, Pierluigi; Forte, Valerio; Ficarra, Vincenzo; Rossanese, Marta; Mucciardi, Giuseppe; Pagliarulo, Vincenzo; Tafuri, Alessandro; Mirone, Vincenzo; Schips, Luigi; Antonelli, Alessandro; Gontero, Paolo; Cormio, Luigi; Sciarra, Alessandro; Porpiglia, Francesco; Bassi, Pierfrancesco; Ditonno, Pasquale; Boström, Peter J; Messina, Emanuele; Panebianco, Valeria; De Cobelli, Ottavio; Carrieri, Giuseppe. - In: WORLD JOURNAL OF UROLOGY. - ISSN 0724-4983. - (2023). [10.1007/s00345-023-04634-2]

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

Busetto, Gian Maria;Ferro, Matteo;Manfredi, Matteo;Brassetti, Aldo;Napolitano, Luigi;Trombetta, Carlo;Maggi, Martina;Del Giudice, Francesco;Forte, Valerio;Schips, Luigi;Antonelli, Alessandro;Sciarra, Alessandro;Messina, Emanuele;Panebianco, Valeria;
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 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.
2023
5-Alpha-reductase inhibitors; Magnetic resonance imaging; Prostate cancer
01 Pubblicazione su rivista::01a Articolo in rivista
Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors / Falagario, Ugo G; Lantz, Anna; Jambor, Ivan; Busetto, Gian Maria; Bettocchi, Carlo; Finati, Marco; Ricapito, Anna; Luzzago, Stefano; Ferro, Matteo; Musi, Gennaro; Totaro, Angelo; Racioppi, Marco; Carbonara, Umberto; Checcucci, Enrico; Manfredi, Matteo; D'Aietti, Damiano; Porcaro, Antonio Benito; Nordström, Tobias; Björnebo, Lars; Oderda, Marco; Soria, Francesco; Taimen, Pekka; Aronen, Hannu J; Perez, Ileana Montoya; Ettala, Otto; Marchioni, Michele; Simone, Giuseppe; Ferriero, Mariaconsiglia; Brassetti, Aldo; Napolitano, Luigi; Carmignani, Luca; Signorini, Claudia; Conti, Andrea; Ludovico, Giuseppe; Scarcia, Marcello; Trombetta, Carlo; Claps, Francesco; Traunero, Fabio; Montanari, Emanuele; Boeri, Luca; Maggi, Martina; Del Giudice, Francesco; Bove, Pierluigi; Forte, Valerio; Ficarra, Vincenzo; Rossanese, Marta; Mucciardi, Giuseppe; Pagliarulo, Vincenzo; Tafuri, Alessandro; Mirone, Vincenzo; Schips, Luigi; Antonelli, Alessandro; Gontero, Paolo; Cormio, Luigi; Sciarra, Alessandro; Porpiglia, Francesco; Bassi, Pierfrancesco; Ditonno, Pasquale; Boström, Peter J; Messina, Emanuele; Panebianco, Valeria; De Cobelli, Ottavio; Carrieri, Giuseppe. - In: WORLD JOURNAL OF UROLOGY. - ISSN 0724-4983. - (2023). [10.1007/s00345-023-04634-2]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1691127
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