| Section 1 Evaluation of the PI-RADS scoring system and MR targeted biopsy for the diagnosis of prostate cancerObjective1. To evaluate the efficiency of Prostate Imaging Reporting and Data System (PI-RADS) for the diagnosis of prostate cancer in Chinese population.2. To compare the efficiency of MR targeted and transrectal ultrasonography guided prostate biopsy for the diagnosis of prostate cancer.Methods1. Retrospectively analyze the cases from July 2014 to March 2016, of which,54 patients accepted MR guided prostate biopsy and 213 patients accepted TRUS guided biopsy. The results of MR imaging and pathologic information were analyzed.2. The PI-RADS score of each Region of Interests (ROIs) was evaluated according to the European Society of Urological Radiology (ESUR) guideline.3. Statistical analysis was carried out with the SPSS 19.0 computer package. Comparisons between the normally distributed data were carried out with Student’ s t-test. Pearson chi-square test was used to compare between count data. The relationship between clinicopathologic characteristics and prostate cancer was analyzed with Spearman correlation analysis. Receiver operating characteristics (ROC) curve was performed to test diagnostic efficacy of mp-MRI. A P value<0.05 was considered statistically significant.Results1. There were no statistical differences between two groups for the patients age, prostate volume and serum PSA(P<0.05). The overall diagnosis rate for prostate cancer was 45.7%, with a higher rate for the MR targeted group (50.0%) than TRUS group (44.6%)(P<0.05). More patients with intermediate and high risk prostate cancer were diagnosed by MR targeted biopsy(77.8%) than TRUS guided biopsy(71.6%)(P<0.05).2.84 ROIs in the MR targeted group were evaluated, of wich 29 were prostate cancer and 55 were BPH. Serum PSA, PSA density, prostate volume, maximum cancer core length were related with biopsy results(p<0.05).3. Compared with BPH, the PI-RAD S score of prostate cancer was higher for T2WI, DWI and PI-RADS and the score of high grade prostate cancer was also higher than that of low grade cancer(P<0.05).4. The area under the curve (AUC) for the detection of prostate cancer was 0.75, 0.85 and 0.82 for T2WI, DWI and PI-RADS, with the sensitivity of 76%,83%, 83%and specificity of 73%,80%,78%.Conclusions1. The PI-RADS scoring system showed high power to detect prostate cancer, which is of great value for the diagnosis of prostate cancer in Chinese population.2. The MR targeted biopsy was more sensitive with intermediate and high risk prostate cancer, which is of great value for the prevention of overdiagnosis and overtreatment of prostate cancer.Section 2 Evaluation of the PI-RADS scoring system and ERG/PTEN status for the prognosis of prostate cancerObjective1. To further evaluate the efficiency of Prostate Imaging Reporting and Data System (PI-RADS) for the diagnosis and prognosis of prostate cancer in Chinese population.2. To analyze the status and prognostic value of TMPRSS2-ERG fusion and PTEN deletion in prostate cancer.3. To explore the incidence and risk factors of unfavorable pathologic events after radical prostatectomy.Methods1. Retrospectively analyze the cases with radical prostatectomy from January 2013 to August 2015. The unfavorable pathologic events includes upstaging, upgrading and positive surgical margin after surgery.2. The PI-RADS score was evaluated according to the European Society of Urological Radiology (ESUR) guideline. TMPRSS2-ERG gene fusion, PTEN deletion status and AR, Ki-67 expression were detected by immunohistochemical analysis of the biopsy specimen.3. Comparison between counting data were carried out with Pearson chi-square test. The relationship between clinicopathologic characteristics and prostate cancer was analyzed with Spearman correlation analysis. Risk Analysis of unfavorable pathologic events was performed with logistic regression analysis. A P value<0.05 was considered statistically significant.Results1. There were 111 cases analyzed, of which the age ranged from 48 to 82 years, with the median age 67.76±7.51. The serum PSA at diagnosis ranged from 2.02 to 67.87 ng/ml. Upgrading was present in 29 cases (26.1%), and 9(8.1%) for upstaging,12(10.8%) for positive surgical margins. The overall unfavorable pathologic events were present in 37 cases (33.3%).2. The PI-RADS score was correlated with serum PSA, clinical staging, Gleason score, number of positive biopsy cores, and maximum cancer core length (P< 0.05). The T2WI score was correlated with clinical staging, Gleason score, and number of positive biopsy cores. Patients with higher DWI score showed higher risk for high grade tumors other than clinical staging.3. Positive ERG staining was present only in prostate cancer and prostatic intraepithelial neoplasia (PIN), with the overall positive rate being 20.7%. PTEN positive staining showed in all the benign tissue and 72.1% of the tumor tissue. The ERG and PTEN mutation rate were more frequent in patients with higher Gleason score. The ERG positive rate was 50.0% in patients with Gleason score higher than 8, which is 42.9% for PTEN deletion(P<0.05).4. Serum PSA>20ng/ml was independent risk factor for upgrading after surgery, with OR to be 18.71(95%CI:2.05-171.14), and the risk of positive surgical margins was 23 times higher in patients with PTEN deletion(95%CI:1.58～ 336.38).Conclusions1. Multiparametric MRI and the PI-RADS scoring system were reliable for the clinical staging and risk stratification of prostate cancer in Chinese population.2. The ERG gene fusion and PTEN deletion rate were much lower than western countries. ERG expression was correlated with Gleason score and Ki-67, which could be used for prognostic evaluation. PTEN deletion was more frequent in patients with serum PSA> 10ng/ml and higher Gleason score.3. Serum PSA>20ng/ml and PTEN deletion were independent risk factor for unfavorable pathologic events. |
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