Tesis

Rasio Apparent Diffusion Coefficient Lesi Prostat dengan Urine dalam Diagnosis Clinically Significant Prostate Cancer: Penelitian Multi-institusi = Apparent Diffusion Coefficient Ratio of Prostate-Lesion-to-Urine in Clinically Significant Prostate Cancer Diagnosis: Multi-institutional Study.

Latar belakang: Clinically significant prostate cancer (csPCa) merupakan kanker prostat yang mempunyai kemungkinan progresi lokal, metastasis, rekurensi, dan kematian yang sedang hingga tinggi, serta tata laksana yang lebih agresif. Penelitian ini bertujuan untuk membantu diagnosis antara csPCa dan bukan csPCa menggunakan rasio apparent diffusion coefficient (rADC) lesi prostat dengan urine. Metode: Penelitian dilakukan pada lesi prostat kategori 3-5 prostate imaging-reporting and data system yang telah dibiopsi prostat transperineal tertarget magnetic resonance imaging (MRI) dengan ultrasound/MRI fusion software di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo pada Juni 2019 hingga Maret 2021. rADC lesi prostat dengan urine merupakan perbandingan rerata nilai apparent diffusion coefficient (ADC) lesi prostat dan urine di vesica urinaria pada MRI prostat peta ADC potongan aksial multi-institusi. rADC lesi prostat dengan urine antara csPCa (adenokarsinoma asinar prostat dengan skor Gleason ≥ 7) dan bukan csPCa (jaringan prostat nonneoplastik atau adenokarsinoma asinar prostat dengan skor Gleason 6) dibandingkan dan ditentukan nilai titik potongnya menggunakan receiver operating curve. Hasil: Terdapat perbedaan rADC lesi prostat dengan urine yang bermakna antara 19 lesi prostat yang merupakan csPCa dan 35 lesi prostat yang bukan merupakan csPCa, dengan nilai tengah rADC lesi prostat dengan urine pada csPCa 0,21 (0,11-0,33), nilai tengah rADC lesi prostat dengan urine pada bukan csPCa 0,43 (0,30-0,61), dan nilai p < 0,001. Nilai titik potong rADC lesi prostat dengan urine dalam membedakan csPCa dan bukan csPCa adalah 0,30 dengan sensitivitas 94,73% dan spesifisitas 100%, area under curve 0,998 (IK95% 0,994-1,000), serta nilai p < 0,001. Kesimpulan: rADC lesi prostat dengan urine dapat membantu diagnosis csPCa dan bukan csPCa pada lesi prostat sebelum biopsi prostat yang tidak invasif, mudah dikerjakan, serta tidak membutuhkan persiapan dan pemeriksaan tambahan.
Kata kunci: Rasio apparent diffusion coefficient, clinically significant prostate cancer


Background: Clinically significant prostate cancer (csPCa) is prostate cancer with moderate to high probability of local progression, metastasis, recurrence, and death, as well as more aggressive management. This study aims to aid diagnose between csPCa and non-csPCa using apparent diffusion coefficient ratio (rADC) of prostate-lesion-tourine. Methods: This study analyze prostate lesions with prostate imaging-reporting and data system category 3-5 that underwent magnetic resonance imaging (MRI)-targeted transperineal prostate biopsy using ultrasound/MRI fusion software at Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo from June 2019 to March 2021. rADC of prostate-lesion-to-urine is defined as comparison between mean apparent diffusion coefficient (ADC) value of prostate lesion and urine in urinary bladder from axial section of ADC map of multi-institutional prostate MRI. rADC of prostate-lesionto-urine between csPCa (acinar adenocarcinoma of the prostate with Gleason score ≥ 7) and non-csPCa (non-neoplastic prostate tissue or acinar adenocarcinoma of the prostate with Gleason score 6) is compared and the cutoff point is determined using receiver operating curve. Results: There is significance rADC of prostate-lesion-to-urine difference between 19 prostate lesions with csPCa and 35 prostate lesions with non-csPCa, with mean rADC of prostate-lesion-to-urine in csPCa is 0.21 (0.11-0.33), mean rADC of prostate-lesionto-urine in non-csPCa is 0.43 (0.30-0.61), and p value is < 0.001. The cut-off value of rADC of prostate-lesion-to-urine to differentiate between csPCa and non-csPCa is 0.30, with 94.73% sensitivity and 100% specificity, area under curve is 0.998 (CI95% 0.9941.000), and p value is < 0.001. Conclusion: rADC of prostate-lesion-to-urine may help diagnose between csPCa and non-csPCa in prostate lesions before prostate biopsy, which is non-invasive, easy to perform, does not require additional preparation and examination.
Key words: Apparent diffusion coefficient ratio, clinically significant prostate cancer