1
|
Wee NK, Tan CH, Choo ZW, Lee CH. Determinants of decision-making in biopsy of PI-RADS 3 transition zone lesions. Singapore Med J 2024:00077293-990000000-00151. [PMID: 39287507 DOI: 10.4103/singaporemedj.smj-2024-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Cancer rates for Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions are low. We aimed to determine the clinical and magnetic resonance imaging (MRI) parameters that can provide risk stratification for PI-RADS 3 transition zone (TZ) lesions to guide decision for biopsy, which can improve the cost-effectiveness of resource utilisation. METHODS The MRI scans of all patients who underwent MRI-ultrasound fusion targeted biopsy from 1 May 2016 to 31 December 2022 were retrospectively assessed by two board-certified abdominal radiologists. The following data were collected and analysed serum prostate-specific antigen, Prostatic Health Index (PHI), prostate volume, histological results, lesion size, location, diffusion-weighted imaging (DWI) parameter scores and overall PI-RADS score. RESULTS Two hundred and fourteen TZ lesions were included. Among 131 PI-RADS 3 lesions, those with marked restricted diffusion (DWI score ≥4), diameter ≥1 cm, prostrate-specific antigen density (PSAD) ≥0.11 and PHI ≥34 were more likely to contain clinically significant prostate cancer (csPCa; P = 0.04, 0.02, 0.049 and 0.05, respectively), with areas under the receiver operating characteristics curve of 0.9, 0.76, 0.84 and 0.80, respectively. Apical lesions were more likely to contain csPCa compared to midgland or basal lesions (P = 0.01). CONCLUSION Clinical parameters (PSAD and PHI) and MRI features (lesion size, DWI score, lesion location) can be used to risk stratify PI-RADS 3 TZ lesions and guide decision for targeted biopsy.
Collapse
Affiliation(s)
- Nicole Kessa Wee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Zhen Wei Choo
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
2
|
Yang L, Zhang T, Liu S, Ding H, Li Z, Zhang Z. Diagnostic Performance of Multiparametric MRI for the Detection of suspected Prostate Cancer in Biopsy-Naive Patients: A Systematic Review and Meta-analysis. Acad Radiol 2024:S1076-6332(24)00590-7. [PMID: 39227219 DOI: 10.1016/j.acra.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/03/2024] [Accepted: 08/14/2024] [Indexed: 09/05/2024]
Abstract
RATIONALE AND OBJECTIVES This meta-analysis aimed to assess the diagnostic accuracy of multiparametric MRI (mpMRI) in detecting suspected prostate cancer (PCa) in biopsy-naive men. MATERIALS AND METHODS PubMed, Scopus, and the Cochrane Library databases were systematically searched for studies published from January 2013 to April 2024. Sixteen studies comprising 4973 patients met the inclusion criteria. Data were extracted to construct 2×2 contingency tables for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A random-effects model was used for pooled estimation, and subgroup analyses were conducted. Summary receiver operating characteristic (SROC) curves were generated to summarize overall diagnostic performance. RESULTS The overall detection rate of PCa across studies was 57.3%. For detecting any PCa, mpMRI showed pooled sensitivity of 82% (95% CI, 80-83%) and specificity of 62% (95% CI, 60-64%), with positive likelihood ratio (LR) of 1.97 (95% CI, 1.71-2.26), negative LR of 0.28 (95% CI, 0.24-0.34), and diagnostic odds ratio (DOR) of 7.34 (95% CI, 5.60-9.63), and an area under the SROC curve of 0.81. For clinically significant PCa (csPCa), mpMRI had pooled sensitivity of 88% (95% CI, 87-90%) and specificity of 64% (95% CI, 63-66%), with positive LR of 2.49 (95% CI, 2.03-3.05), negative LR of 0.20 (95% CI, 0.16-0.25), DOR of 13.83 (95% CI, 9.14-20.9), and area under the curve of 0.90. CONCLUSION This meta-analysis suggests that mpMRI is effective in detecting PCa in biopsy-naive patients, particularly for csPCa. It can help reduce unnecessary biopsies and lower the risk of missing clinically significant cases, thereby guiding informed biopsy decisions.
Collapse
Affiliation(s)
- Lei Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Radiology, Qingdao Women and Children's Hospital, Qingdao, China
| | - Taijuan Zhang
- Department of Radiology, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, China
| | - Shunli Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui Ding
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhiming Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zaixian Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| |
Collapse
|
3
|
Oerther B, Nedelcu A, Engel H, Schmucker C, Schwarzer G, Brugger T, Schoots IG, Eisenblaetter M, Sigle A, Gratzke C, Bamberg F, Benndorf M. Update on PI-RADS Version 2.1 Diagnostic Performance Benchmarks for Prostate MRI: Systematic Review and Meta-Analysis. Radiology 2024; 312:e233337. [PMID: 39136561 DOI: 10.1148/radiol.233337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Background Prostate MRI for the detection of clinically significant prostate cancer (csPCa) is standardized by the Prostate Imaging Reporting and Data System (PI-RADS), currently in version 2.1. A systematic review and meta-analysis infrastructure with a 12-month update cycle was established to evaluate the diagnostic performance of PI-RADS over time. Purpose To provide estimates of diagnostic accuracy and cancer detection rates (CDRs) of PI-RADS version 2.1 categories for prostate MRI, which is required for further evidence-based patient management. Materials and Methods A systematic search of PubMed, Embase, Cochrane Library, and multiple trial registers (English-language studies published from March 1, 2019, to August 30, 2022) was performed. Studies that reported data on diagnostic accuracy or CDRs of PI-RADS version 2.1 with csPCa as the primary outcome were included. For the meta-analysis, pooled estimates for sensitivity, specificity, and CDRs were derived from extracted data at the lesion level and patient level. Sensitivity and specificity for PI-RADS greater than or equal to 3 and PI-RADS greater than or equal to 4 considered as test positive were investigated. In addition to individual PI-RADS categories 1-5, subgroup analyses of subcategories (ie, 2+1, 3+0) were performed. Results A total of 70 studies (11 686 lesions, 13 330 patients) were included. At the patient level, with PI-RADS greater than or equal to 3 considered positive, meta-analysis found a 96% summary sensitivity (95% CI: 95, 98) and 43% specificity (95% CI: 33, 54), with an area under the summary receiver operating characteristic (SROC) curve of 0.86 (95% CI: 0.75, 0.93). For PI-RADS greater than or equal to 4, meta-analysis found an 89% sensitivity (95% CI: 85, 92) and 66% specificity (95% CI: 58, 74), with an area under the SROC curve of 0.89 (95% CI: 0.85, 0.92). CDRs were as follows: PI-RADS 1, 6%; PI-RADS 2, 5%; PI-RADS 3, 19%; PI-RADS 4, 54%; and PI-RADS 5, 84%. The CDR was 12% (95% CI: 7, 19) for transition zone 2+1 lesions and 19% (95% CI: 12, 29) for 3+0 lesions (P = .12). Conclusion Estimates of diagnostic accuracy and CDRs for PI-RADS version 2.1 categories are provided for quality benchmarking and to guide further evidence-based patient management. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Tammisetti and Jacobs in this issue.
Collapse
Affiliation(s)
- Benedict Oerther
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Andrea Nedelcu
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Hannes Engel
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Christine Schmucker
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Guido Schwarzer
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Timo Brugger
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Ivo G Schoots
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Michel Eisenblaetter
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - August Sigle
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Christian Gratzke
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Fabian Bamberg
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| | - Matthias Benndorf
- From the Department of Radiology (B.O., A.N., H.E., F.B., M.B.), Institute for Evidence in Medicine (C.S., T.B.), Institute of Medical Biometry and Statistics (G.S.), Department of Urology (A.S., C.G.), and Berta-Ottenstein-Programme (A.S), Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany; Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands (I.G.S); and Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Klinikum Lippe, Röntgenstrasse 18, 32756 Detmold, Germany (M.E., M.B.)
| |
Collapse
|
4
|
Wang S, Kozarek J, Russell R, Drescher M, Khan A, Kundra V, Barry KH, Naslund M, Siddiqui MM. Diagnostic Performance of Prostate-specific Antigen Density for Detecting Clinically Significant Prostate Cancer in the Era of Magnetic Resonance Imaging: A Systematic Review and Meta-analysis. Eur Urol Oncol 2024; 7:189-203. [PMID: 37640584 DOI: 10.1016/j.euo.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/31/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
CONTEXT There has been a dramatic increase in the use of prostate magnetic resonance imaging (MRI) in the diagnostic workup. With prostate volume calculated from MRI, prostate-specific antigen density (PSAD) now is a ready-to-use parameter for prostate cancer (PCa) risk stratification before prostate biopsy, especially among patients with negative MRI or equivocal lesions. OBJECTIVE In this review, we aimed to evaluate the diagnostic performance of PSAD for clinically significant prostate cancer (CSPCa) among patients who received MRI before prostate biopsy. EVIDENCE ACQUISITION Two investigators performed a systematic review according of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Studies (published between January 1, 2012, and December 31, 2021) reporting the diagnostic performance (outcomes) of PSAD (intervention) for CSPCa among men who received prebiopsy prostate MRI and subsequent prostate biopsy (patients), using biopsy pathology as the gold standard (comparison), were eligible for inclusion. EVIDENCE SYNTHESIS A total of 1536 papers were identified in PubMed, Scopus, and Embase. Of these, 248 studies were reviewed in detail and 39 were qualified. The pooled sensitivity (SENS) and specificity (SPEC) for diagnosing CSPCa among patients with positive MRI were, respectively, 0.87 and 0.35 for PSAD of 0.1 ng/ml/ml, 0.74 and 0.61 for PSAD of 0.15 ng/ml/ml, and 0.51 and 0.81 for PSAD of 0.2 ng/ml/ml. The pooled SENS and SPEC for diagnosing CSPCa among patients with negative MRI were, respectively, 0.85 and 0.36 for PSAD of 0.1 ng/ml/ml, 0.60 and 0.66 for PSAD of 0.15 ng/ml/ml, and 0.33 and 0.84 for PSAD of 0.2 ng/ml/ml. The pooled SENS and SPEC among patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 or Likert 3 lesions were, respectively, 0.87 and 0.39 for PSAD of 0.1 ng/ml/ml, 0.61 and 0.69 for PSAD of 0.15 ng/ml/ml, and 0.42 and 0.82 for PSAD of 0.2 ng/ml/ml. The post-test probability for CSPCa among patients with negative MRI was 6% if PSAD was <0.15 ng/ml/ml and dropped to 4% if PSAD was <0.10 ng/ml/ml. CONCLUSIONS In this systematic review, we quantitatively evaluated the diagnosis performance of PSAD for CSPCa in combination with prostate MRI. It demonstrated a complementary performance and predictive value, especially among patients with negative MRI and PI-RADS 3 or Likert 3 lesions. Integration of PSAD into decision-making for prostate biopsy may facilitate improved risk-adjusted care. PATIENT SUMMARY Prostate-specific antigen density is a ready-to-use parameter in the era of increased magnetic resonance imaging (MRI) use in clinically significant prostate cancer (CSPCa) diagnosis. Findings suggest that the chance of having CSPCa was very low (4% or 6% for those with negative prebiopsy MRI or Prostate Imaging Reporting and Data System (Likert) score 3 lesion, respectively, if the PSAD was <0.10 ng/ml/ml), which may lower the need for biopsy in these patients.
Collapse
Affiliation(s)
- Shu Wang
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Kozarek
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Ryan Russell
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Max Drescher
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amir Khan
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vikas Kundra
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathryn Hughes Barry
- Division of Cancer Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Naslund
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Veterans Affairs Maryland Healthcare System, Baltimore, MD, USA.
| |
Collapse
|
5
|
Haj-Mirzaian A, Burk KS, Lacson R, Glazer DI, Saini S, Kibel AS, Khorasani R. Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e244258. [PMID: 38551559 PMCID: PMC10980971 DOI: 10.1001/jamanetworkopen.2024.4258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/02/2024] [Indexed: 04/01/2024] Open
Abstract
Importance Multiple strategies integrating magnetic resonance imaging (MRI) and clinical data have been proposed to determine the need for a prostate biopsy in men with suspected clinically significant prostate cancer (csPCa) (Gleason score ≥3 + 4). However, inconsistencies across different strategies create challenges for drawing a definitive conclusion. Objective To determine the optimal prostate biopsy decision-making strategy for avoiding unnecessary biopsies and minimizing the risk of missing csPCa by combining MRI Prostate Imaging Reporting & Data System (PI-RADS) and clinical data. Data Sources PubMed, Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to July 1, 2022. Study Selection English-language studies that evaluated men with suspected but not confirmed csPCa who underwent MRI PI-RADS followed by prostate biopsy were included. Each study had proposed a biopsy plan by combining PI-RADS and clinical data. Data Extraction and Synthesis Studies were independently assessed for eligibility for inclusion. Quality of studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and the Newcastle-Ottawa Scale. Mixed-effects meta-analyses and meta-regression models with multimodel inference were performed. Reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Main Outcomes and Measures Independent risk factors of csPCa were determined by performing meta-regression between the rate of csPCa and PI-RADS and clinical parameters. Yields of different biopsy strategies were assessed by performing diagnostic meta-analysis. Results The analyses included 72 studies comprising 36 366 patients. Univariable meta-regression showed that PI-RADS 4 (β-coefficient [SE], 7.82 [3.85]; P = .045) and PI-RADS 5 (β-coefficient [SE], 23.18 [4.46]; P < .001) lesions, but not PI-RADS 3 lesions (β-coefficient [SE], -4.08 [3.06]; P = .19), were significantly associated with a higher risk of csPCa. When considered jointly in a multivariable model, prostate-specific antigen density (PSAD) was the only clinical variable significantly associated with csPCa (β-coefficient [SE], 15.50 [5.14]; P < .001) besides PI-RADS 5 (β-coefficient [SE], 9.19 [3.33]; P < .001). Avoiding biopsy in patients with lesions with PI-RADS category of 3 or less and PSAD less than 0.10 (vs <0.15) ng/mL2 resulted in reducing 30% (vs 48%) of unnecessary biopsies (compared with performing biopsy in all suspected patients), with an estimated sensitivity of 97% (vs 95%) and number needed to harm of 17 (vs 15). Conclusions and Relevance These findings suggest that in patients with suspected csPCa, patient-tailored prostate biopsy decisions based on PI-RADS and PSAD could prevent unnecessary procedures while maintaining high sensitivity.
Collapse
Affiliation(s)
- Arya Haj-Mirzaian
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristine S. Burk
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel I. Glazer
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sanjay Saini
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S. Kibel
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
6
|
Malewski W, Milecki T, Szempliński S, Tayara O, Kuncman Ł, Kryst P, Nyk Ł. Prostate Biopsy in the Case of PIRADS 5-Is Systematic Biopsy Mandatory? J Clin Med 2023; 12:5612. [PMID: 37685679 PMCID: PMC10488368 DOI: 10.3390/jcm12175612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically significant prostate cancer (csPC) detection in TB. Potentially, omitting SB in the case of PIRADS 5 may have a marginal impact on the csPC detection rate. The aim of this study was to determine whether SB can be avoided in the case of PIRADS 5 and to identify potential factors allowing for performing TB only. This cohort study involved n = 225 patients with PIRADS 5 on mpMRI (PIRADS 2.0/2.1) who underwent transperineal or transrectal combined biopsy (CB). CsPC was diagnosed in 51.6% (n = 116/225) of cases. TB and SB resulted in the detection of csPC in 48% (n = 108/225) and 20.4% (n = 46/225) of cases, respectively (TB vs. SB, p < 0.001). When the TB was positive, SB detected csPC in n = 38 of the cases (38/108 = 35%). SB added to TB significantly improved csPC detection in 6.9% of cases in absolute terms (n = 8/116) (TB vs. CB, p = 0.008). The multivariate regression model proved that the significant predictors of csPC detection via SB were the densities of the prostate-specific antigen-PSAD > 0.17 ng/mL2 (OR = 4.038, 95%CI: 1.568-10.398); primary biopsy setting (OR = 2.818, 95%CI: 1.334-5.952); and abnormal digital rectal examination (DRE) (OR = 2.746, 95%CI: 1.328-5.678). In a primary biopsy setting (n = 103), SB detected 10% (n = 6/60) of the additional cases of csPC (p = 0.031), while in a repeat biopsy setting (n = 122), SB detected 3.5% (n = 2/56) of the additional cases of csPC (p = 0.5). In the case of PSAD > 0.17 ng/mL2 (n = 151), SB detected 7.4% (n = 7/95) of additional cases of csPC (p = 0.016), while in the case of PSAD < 0.17 ng/mL2 (n = 74), SB detected 4.8% (n = 1/21) of the additional cases of csPC (p = 1.0). The omission of SB had an impact on the csPC diagnosis rate in patients with PIRADS 5 score lesions. Patients who have already undergone prostate biopsy and those with low PSAD are at a lower risk of missing csPC when SB is avoided. However, performing TB only may result in missing other csPC foci located outside the index lesion, which can alter treatment decisions.
Collapse
Affiliation(s)
- Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Tomasz Milecki
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Omar Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Łukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| |
Collapse
|
7
|
Cereser L, Evangelista L, Giannarini G, Girometti R. Prostate MRI and PSMA-PET in the Primary Diagnosis of Prostate Cancer. Diagnostics (Basel) 2023; 13:2697. [PMID: 37627956 PMCID: PMC10453091 DOI: 10.3390/diagnostics13162697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Over the last years, prostate magnetic resonance imaging (MRI) has gained a key role in the primary diagnosis of clinically significant prostate cancer (csPCa). While a negative MRI can avoid unnecessary prostate biopsies and the overdiagnosis of indolent cancers, a positive examination triggers biopsy samples targeted to suspicious imaging findings, thus increasing the diagnosis of csPCa with a sensitivity and negative predictive value of around 90%. The limitations of MRI, including suboptimal positive predictive values, are fueling debate on how to stratify biopsy decisions and management based on patient risk and how to correctly estimate it with clinical and/or imaging findings. In this setting, "next-generation imaging" imaging based on radiolabeled Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is expanding its indications both in the setting of primary staging (intermediate-to-high risk patients) and primary diagnosis (e.g., increasing the sensitivity of MRI or acting as a problem-solving tool for indeterminate MRI cases). This review summarizes the current main evidence on the role of prostate MRI and PSMA-PET as tools for the primary diagnosis of csPCa, and the different possible interaction pathways in this setting.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, 20072 Milan, Italy;
- University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Gianluca Giannarini
- Urology Unit, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, 20072 Milan, Italy;
- University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| |
Collapse
|
8
|
Girometti R, Giannarini G, De Martino M, Caregnato E, Cereser L, Soligo M, Rozze D, Pizzolitto S, Isola M, Zuiani C. Multivariable stratification of PI-RADS version 2.1 categories for the risk of false-positive target biopsy: Impact on prostate biopsy decisions. Eur J Radiol 2023; 165:110897. [PMID: 37300933 DOI: 10.1016/j.ejrad.2023.110897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/30/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To identify clinical and multiparametric magnetic resonance imaging (mpMRI) factors predicting false positive target biopsy (FP-TB) of prostate imaging reporting and data system version 2.1 (PI-RADSv2.1) ≥ 3 findings. METHOD We retrospectively included 221 men with and without previous negative prostate biopsy who underwent 3.0 T/1.5 T mpMRI for suspicious clinically significant prostate cancer (csPCa) between April 2019-July 2021. A study coordinator revised mpMRI reports provided by one of two radiologists (experience of > 1500/>500 mpMRI examinations, respectively) and matched them with the results of transperineal systematic biopsy plus fusion target biopsy (TB) of PI-RADSv2.1 ≥ 3 lesions or PI-RADSv2.1 ≤ 2 men with higher clinical risk. A multivariable model was built to identify features predicting FP-TB of index lesions, defined as the absence of csPCa (International Society of Urogenital Pathology [ISUP] ≥ 2). The model was internally validated with the bootstrap technique, receiving operating characteristics (ROC) analysis, and decision analysis. RESULTS Features significantly associated with FP-TB were age < 65 years (odds ratio [OR] 2.77), prostate-specific antigen density (PSAD) < 0.15 ng/mL/mL (OR 2.45), PI-RADS 4/5 category vs. category 3 (OR 0.15/0.07), and multifocality (OR 0.46), with a 0.815 area under the curve (AUC) in assessing FP-TB. When adjusting PI-RADSv2.1 categorization for the model, mpMRI showed 87.5% sensitivity and 79.9% specificity for csPCa, with a greater net benefit in triggering biopsy compared to unadjusted categorization or adjustment for PSAD only at decision analysis, from threshold probability ≥ 15%. CONCLUSION Adjusting PI-RADSv2.1 categories for a multivariable risk of FP-TB is potentially more effective in triggering TB of index lesions than unadjusted PI-RADS categorization or adjustment for PSAD alone.
Collapse
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Maria De Martino
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine, Udine, Italy, pl.le Kolbe, 4, 33100 Udine, Italy
| | - Elena Caregnato
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| | - Matteo Soligo
- Urology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Davide Rozze
- Pathology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Miriam Isola
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine, Udine, Italy, pl.le Kolbe, 4, 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| |
Collapse
|
9
|
Girometti R, Giannarini G, Peruzzi V, Amparore D, Pizzolitto S, Zuiani C. MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition. Eur J Radiol 2023; 164:110852. [PMID: 37167683 DOI: 10.1016/j.ejrad.2023.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Quality is currently recognized as the pre-requisite for delivering the clinical benefits expected by magnetic resonance imaging (MRI)-informed prostate biopsy (MRI-i-PB) in patients with a suspicion for clinically significant prostate cancer (csPCa). The "quality chain" underlying MRI-i-PB is multidisciplinary in nature, and depends on several factors related to the patient, imaging technique, image interpretation and biopsy procedure. This review aims at making the radiologist aware of biopsy-related factors impacting on MRI-i-PB quality, both in terms of biopsy planning (threshold for biopsy decisions, association with systematic biopsy and number of targeted cores) and biopsy acquisition (biopsy route, targeting technique, and operator's experience). While there is still space for improvement and better standardization of several biopsy-related procedures, current evidence suggests that high-quality MRI-i-PB can be delivered by acquiring and increased the number of biopsy cores targeted to suspicious imaging findings and perilesional area ("focal saturation biopsy"). On the other hand, uncertainty still exists as to whether software-assisted fusion of MRI and transrectal ultrasound images can outperform cognitive fusion strategy. The role for operator's experience and quality assurance/quality control procedures are also discussed.
Collapse
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Torino, Italy.
| | - Stefano Pizzolitto
- Unit of Pathology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| |
Collapse
|
10
|
Jin P, Shen J, Yang L, Zhang J, Shen A, Bao J, Wang X. Machine learning-based radiomics model to predict benign and malignant PI-RADS v2.1 category 3 lesions: a retrospective multi-center study. BMC Med Imaging 2023; 23:47. [PMID: 36991347 PMCID: PMC10053087 DOI: 10.1186/s12880-023-01002-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose To develop machine learning-based radiomics models derive from different MRI sequences for distinction between benign and malignant PI-RADS 3 lesions before intervention, and to cross-institution validate the generalization ability of the models. Methods The pre-biopsy MRI datas of 463 patients classified as PI-RADS 3 lesions were collected from 4 medical institutions retrospectively. 2347 radiomics features were extracted from the VOI of T2WI, DWI and ADC images. The ANOVA feature ranking method and support vector machine classifier were used to construct 3 single-sequence models and 1 integrated model combined with the features of three sequences. All the models were established in the training set and independently verified in the internal test and external validation set. The AUC was used to compared the predictive performance of PSAD with each model. Hosmer–lemeshow test was used to evaluate the degree of fitting between prediction probability and pathological results. Non-inferiority test was used to check generalization performance of the integrated model. Results The difference of PSAD between PCa and benign lesions was statistically significant (P = 0.006), with the mean AUC of 0.701 for predicting clinically significant prostate cancer (internal test AUC = 0.709 vs. external validation AUC = 0.692, P = 0.013) and 0.630 for predicting all cancer (internal test AUC = 0.637 vs. external validation AUC = 0.623, P = 0.036). T2WI-model with the mean AUC of 0.717 for predicting csPCa (internal test AUC = 0.738 vs. external validation AUC = 0.695, P = 0.264) and 0.634 for predicting all cancer (internal test AUC = 0.678 vs. external validation AUC = 0.589, P = 0.547). DWI-model with the mean AUC of 0.658 for predicting csPCa (internal test AUC = 0.635 vs. external validation AUC = 0.681, P = 0.086) and 0.655 for predicting all cancer (internal test AUC = 0.712 vs. external validation AUC = 0.598, P = 0.437). ADC-model with the mean AUC of 0.746 for predicting csPCa (internal test AUC = 0.767 vs. external validation AUC = 0.724, P = 0.269) and 0.645 for predicting all cancer (internal test AUC = 0.650 vs. external validation AUC = 0.640, P = 0.848). Integrated model with the mean AUC of 0.803 for predicting csPCa (internal test AUC = 0.804 vs. external validation AUC = 0.801, P = 0.019) and 0.778 for predicting all cancer (internal test AUC = 0.801 vs. external validation AUC = 0.754, P = 0.047). Conclusions The radiomics model based on machine learning has the potential to be a non-invasive tool to distinguish cancerous, noncancerous and csPCa in PI-RADS 3 lesions, and has relatively high generalization ability between different date set.
Collapse
Affiliation(s)
- Pengfei Jin
- grid.509676.bDepartment of Radiology, The Cancer Hospital of the University of Chinese Academy of Science (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Science, 1# Banshan East Road, Hangzhou, 310022 Zhejiang China
| | - Junkang Shen
- grid.452666.50000 0004 1762 8363Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055# Sanxiang Road, Suzhou, 215000 China
| | - Liqin Yang
- grid.429222.d0000 0004 1798 0228Department of Radiology, The First Affiliated Hospital of SooChow University, 188#, Shizi Road, Suzhou, 215006 Jiangsu China
| | - Ji Zhang
- grid.479690.50000 0004 1789 6747Department of Radiology, Taizhou People’s Hospital of Jiangsu Province, 10# Yigchun Road, Taizhou, 225300 Jiangsu China
| | - Ao Shen
- grid.9227.e0000000119573309Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, 88# Keling Road, Suzhou, 215163 Jiangsu China
| | - Jie Bao
- grid.429222.d0000 0004 1798 0228Department of Radiology, The First Affiliated Hospital of SooChow University, 188#, Shizi Road, Suzhou, 215006 Jiangsu China
| | - Ximing Wang
- grid.429222.d0000 0004 1798 0228Department of Radiology, The First Affiliated Hospital of SooChow University, 188#, Shizi Road, Suzhou, 215006 Jiangsu China
| |
Collapse
|
11
|
Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy. Cancers (Basel) 2022; 14:cancers14102374. [PMID: 35625978 PMCID: PMC9139805 DOI: 10.3390/cancers14102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 02/01/2023] Open
Abstract
This study is a head-to-head comparison between mPSAD and MRI-PMbdex. The MRI-PMbdex was created from 2432 men with suspected PCa; this cohort comprised the development and external validation cohorts of the Barcelona MRI predictive model. Pre-biopsy 3-Tesla multiparametric MRI (mpMRI) and 2 to 4-core transrectal ultrasound (TRUS)-guided biopsies for suspicious lesions and/or 12-core TRUS systematic biopsies were scheduled. Clinically significant PCa (csPCa), defined as Gleason-based Grade Group 2 or higher, was detected in 934 men (38.4%). The area under the curve was 0.893 (95% confidence interval [CI]: 0.880−0.906) for MRI-PMbdex and 0.764 (95% CI: 0.774−0.783) for mPSAD, with p < 0.001. MRI-PMbdex showed net benefit over biopsy in all men when the probability of csPCa was greater than 2%, while mPSAD did the same when the probability of csPCa was greater than 18%. Thresholds of 13.5% for MRI-PMbdex and 0.628 ng/mL2 for mPSAD had 95% sensitivity for csPCa and presented 51.1% specificity for MRI-PMbdex and 19.6% specificity for mPSAD, with p < 0.001. MRI-PMbdex exhibited net benefit over mPSAD in men with prostate imaging report and data system (PI-RADS) <4, while neither exhibited any benefit in men with PI-RADS 5. Hence, we can conclude that MRI-PMbdex is more accurate than mPSAD for the proper selection of candidates for prostate biopsy among men with suspected PCa, with the exception of men with a PI-RAD S 5 score, for whom neither tool exhibited clinical guidance to determine the need for biopsy.
Collapse
|
12
|
Fütterer JJ, Kim CK, Margolis DJ. Innovations in prostate cancer: introductory editorial. Br J Radiol 2022; 95:20229003. [PMID: 35179398 PMCID: PMC8978236 DOI: 10.1259/bjr.20229003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jurgen J Fütterer
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Daniel J Margolis
- Department of Radiology, Weill Cornell Medical College, New York, USA
| |
Collapse
|