Prostate cancer (PC) is one of the most common malignant tumors in men and the second most important cause of cancer -related death. In fact, most PCs are classified as low risks. Therefore, the conservative treatment including active monitoring (AS) and observation waiting is the preferred process of low -risk PC.
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As far as we know, for men who choose AS, the optimal frequency and composition of subsequent follow -up (such as prostate special antigen [PSA] test, MRI and prostate biopsy) have not yet reached consensus, and the economic impact on different detection schemes The evaluation of the quality of life is also very limited. Specifically, when AS patients were accepted by prostate MRI, the biopsy threshold of prostate imaging reports and data systems (PI-RADS) did not reach a consensus. Although the PI-RADS score is 3 points is a commonly used biopsy standard, in some cases, the threshold with a PI-RADS score of 4 points may be the best benefit of patients by improving specificity.
In order to evaluate the comparative cost, effectiveness and benefits and harm of the prostate MRI in AS, including using different PI-RADS scores as the standard for biopsy. Recently, a study published in the Radiology magazine is diagnosed with male patients with local low-risk PCs. China developed and verified a micro -simulation model to compare whether the effectiveness and cost benefits of the AS strategy of the prostate MRI, which provided a valuable reference basis for further guiding the use process of prostate MRI.
This study has established a mathematical model of the cost benefits of the simulation monitoring scheme of low -risk PC patients. The following solutions are compared: observation waiting, prostate special antigen (PSA) and annual biopsy without MRI examinations, as well as PSA detection and different differentials MRI examination of PI-RADS biopsy threshold. The MRI scheme scores at least 3 points or at least 4 points in the time arrangement and the use of the PI-RADS score to indicate that the biopsy is required. Use a micro simulation method to calculate the year of life, adjust the year of life (QALYS), and incremental cost benefits. Sensitive analysis is used to evaluate the effects of different parameters on the results.
In terms of the basic situation of 60 -year -old men, compared with observation waiting and non -MRI solutions, all solutions including prostate MRI have extended QALYS and the Year of life. The annual MRI solution generated 16.19 QALYS, annual biopsy and MRI -free QALYS, observation waits for 15.94 QALYS. An annual MRI with a PI-RADS score at least 3 points or at least 4 points as a biopsy threshold, and the annual MRI of the year even under the condition of MRI negative, provides similar QALY and the same unsettled life span: 23.05 Life Year. However, when the PI-RADS score is at least 4 points into a threshold, the number of biopsys in a lifetime decreases by 42%. At the cost and benefit threshold of $ 100,000 for each QALY, the MRI examination and biopsy of PI-RADS are the highest (incremental cost-effectiveness ratio, $ 67 221 per Q 67 221) each year. The risk of age, treatment type, initial level error classification, and programmatic complications have a certain impact on the results on the quality of life.
This study shows that compared with active monitoring (AS) that does not often perform prostate MRI examinations or does not perform prostate MRI examinations, the annual MRI monitoring scheme can bring the biggest expectations (Le) and quality adjustment of prostate cancer patients (Le) and quality adjustment. QALE) benefits. At the same time, the 2nd edition of the previously prostate imaging report and data system (PI-RADS) was divided into 4 points as a biopsy standard for the annual MRI annual MRI of the low-risk prostate cancer. Compared with the use of PI-RADS scores, it can greatly reduce the number of biopsy times. And Le and QALE are basically equal. This study provides a valuable reference basis for clinically adjusted the diagnosis and treatment plan of patients with prostate cancer.
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Stella K Kang，Rahul D Mali，Vinay Prabhu，et al.Active Surveillance Strategies for Low-Grade Prostate Cancer： Comparative Benefits and Cost-effectiveness.DOI：10.1148/radiol.2021204321