Zehra Hilal ADİBELLİ, İbrahim Halil BOZKURT, Ertuğrul ŞEFİK, Bülent GÜNLÜSOY, Enver VARDAR, Hülya MOLLAMEHMETOĞLU, Gülşen YÜCEL OĞUZDOĞAN

PROSTAT BEZİNİN FARMAKOKİNETİK ANALİZİ VE BENİGN-MALİGN HASTALIKLAR İLE FARMOKOKİNETİK PARAMETRELERİN KORELASYONU

Giriş: Bu prospektif çal ışmanın amacı, kantitatif-semikantitatif multiparametrik manyetik rezonans görüntüleme (MpMRG) parametrelerinin prostat kanserini (PKa) benign prostat lezyonlarından ay ırt etmedeki katkısını değerlendirerek, kanserin patolojik derecesi (ISUP skoru) ile korelasyonunu incelemektir. Gereç ve Yöntem: Prospektif çal ışmaya Nisan-Aralık 2019 tarihleri arasında MpMRG yap ılmış, transrektal ultrasonografi e şliğinde kognitif füzyon biyopsisi (TRUS-CF Bx) ile tanı alan hastalar dahil edildi. MpMRG görüntüleri, iki radyolog tarafından PI-RADSv2.1 klavuzuna göre biyopsi öncesinde değerlendirilmiştir. Histopatolojik sonuçların farmakokinetik parametreler ile korelasyonu değerlendirildi. Normal periferik zon (PZ) ve lezyonlara ait kantitatif ve semikantitatif parametreler (Ktrans, Kep, Ve, iAUC, chi2, W-in, W-out, TTP, AT, PEI, iAUC) incelendi. Gleason Skoru (GS) ≥6 olan lezyonlar PKa olarak kabul edildi. Bulgular: Çalışmaya toplam 84 hasta, 106 lezyon dahil edildi. Tüm malign lezyonlarda ISUP gradelerine göre sırasıyla 1-2-3-4-5 gruplarda %37,2, %13,9, %13,9, %13,9, %20,9 dağılım izlendi. Farmakokinetik analizde Ktrans ve Kep ortalaması kanser grubunda en yüksek bulundu. Chi2 değeri kanser grubunda en yüksekti. W-in değeri benign prostatik dokuda en yüksek, normal PZ’de en düşüktü. W-out değeri kanser grubunda en düşük ölçülmüştür. TTP değeri kanser grubunda en düşük ve normal PZ’de en yüksek bulundu. AT prostatit grubunda en yüksekti. PEI değeri benign prostatik doku grubunda en yüksek bulunmuştur. PKa olan grup ile olmayan grup karşılaştırıldığında PKa’da Ktrans, Kkep ve Chi2 değerinin anlamlı olarak daha yüksek olduğu görülmüştür. Kantitatif ve semikantitatif parametrelerin ortalamaları açısında ISUP grupları arasında anlamlı fark bulunmamıştır. Sonuç: PI-RADSV2.1 skorlama sistemi prostat kanseri şüphesi olan hastalarda tanı ve tedavi kararında oldukça etkilidir. PI-RADS, farmakokinetik analizlerin skorlamada daha etkin kullanılarak uluslararası standartlar getirilmesi ile gelecekteki sürümlerinde gelişmeye devam edecektir.

PHARMACOKINETIC ANALYSIS OF THE PROSTATE GLAND, AND CORRELATION OF PHARMACOKINETIC PARAMETERS WITH BENIGN-MALIGN DISEASES

ntroduction: The aim of this prospective study is to evaluate the contribution of quantitative and semi- quantitative parameters of multiparametric magnetic resonance imaging in di stinguishing prostate cancer (PCa) from benign lesions and to examine the relationship between pathological cancer grade (ISUP score) and quantitative and semi-quantitative parameters. Material and Method : Patients who underwent MpMRI and then TRUS-guided cognitive fusion biopsy were included in this prospective study. The MpMRI images were evaluated by two radiologists, based on PI-RADSv2.1 guideline before the biopsy. Quantitative and semi-quantitative parameters (Ktrans, Kep, Ve, iAUC, chi2, W-in, W- out, TTP, AT, PEI, iAUC*), of normal peripheral zone(PZ) and lesions, were recorded. Correlation of the histopathological results with pharmacokinetic parameters were evaluated. The lesions with a pathological GS of ≥6 were considered as malignant. Results: A total of 84 patients and 106 lesions were included in this study. In all malignant lesions, a distribution of 37.2%, 13.9%, 13.9%, 13.9%, and 20.9% was observed in 1-2-3-4-5 groups, respectively, according to ISUP grades. Pharmacokinetic analysis proved that Ktrans and Kep mean values were highest in the PCa. The Chi2 value was the highest in the cancer group. The W-in value was the highest in benign prostatic tissue and the lowest in the normal PZ. The W-out value was the lowest in the PCa. The TTP value was the lowest in the PCa and the highest in the normal PZ. AT was the highest in the prostatitis group. PEI was found to be the highest in benign prostatic tissue group. Ktrans, Kep and Chi2 values were significantly higher in cancer group when the PCa and the non-PCa were compared. No statistically significant difference was found between ISUP groups in terms of means of all parameters. Conclusion: PI-RADSV2.1 scoring system is very effective in the diagnosis and treatment decision of patients with suspected prostate cancer. PI-RADS is expected to evolve in the future ve rsions, with setting up the international standards for pharmacokinetic analysis in MpMRI.

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