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Denijs FB, van Harten MJ, Meenderink JJL, Leenen RCA, Remmers S, Venderbos LDF, van den Bergh RCN, Beyer K, Roobol MJ. Risk calculators for the detection of prostate cancer: a systematic review. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00852-w. [PMID: 38830997 DOI: 10.1038/s41391-024-00852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Prostate cancer (PCa) (early) detection poses significant challenges, including unnecessary testing and the risk of potential overdiagnosis. The European Association of Urology therefore suggests an individual risk-adapted approach, incorporating risk calculators (RCs) into the PCa detection pathway. In the context of 'The PRostate Cancer Awareness and Initiative for Screening in the European Union' (PRAISE-U) project ( https://uroweb.org/praise-u ), we aim to provide an overview of the currently available clinical RCs applicable in an early PCa detection algorithm. METHODS We performed a systematic review to identify RCs predicting detection of clinically significant PCa at biopsy. A search was performed in the databases Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Google Scholar for publications between January 2010 and July 2023. We retrieved relevant literature by using the terms "prostate cancer", "screening/diagnosis" and "predictive model". Inclusion criteria included systematic reviews, meta-analyses, and clinical trials. Exclusion criteria applied to studies involving pre-targeted high-risk populations, diagnosed PCa patients, or a sample sizes under 50 men. RESULTS We identified 6474 articles, of which 140 were included after screening abstracts and full texts. In total, we identified 96 unique RCs. Among these, 45 underwent external validation, with 28 validated in multiple cohorts. Of the externally validated RCs, 17 are based on clinical factors, 19 incorporate clinical factors along with MRI details, 4 were based on blood biomarkers alone or in combination with clinical factors, and 5 included urinary biomarkers. The median AUC of externally validated RCs ranged from 0.63 to 0.93. CONCLUSIONS This systematic review offers an extensive analysis of currently available RCs, their variable utilization, and performance within validation cohorts. RCs have consistently demonstrated their capacity to mitigate the limitations associated with early detection and have been integrated into modern practice and screening trials. Nevertheless, the lack of external validation data raises concerns about numerous RCs, and it is crucial to factor in this omission when evaluating whether a specific RC is applicable to one's target population.
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Affiliation(s)
- Frederique B Denijs
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Meike J van Harten
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonas J L Meenderink
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Renée C A Leenen
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lionne D F Venderbos
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roderick C N van den Bergh
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katharina Beyer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Jahnen M, Hausler T, Meissner VH, Ankerst DP, Kattan MW, Sauter A, Gschwend JE, Herkommer K. Predicting clinically significant prostate cancer following suspicious mpMRI: analyses from a high-volume center. World J Urol 2024; 42:290. [PMID: 38702557 PMCID: PMC11068682 DOI: 10.1007/s00345-024-04991-6] [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: 12/19/2023] [Accepted: 04/04/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE mpMRI is routinely used to stratify the risk of clinically significant prostate cancer (csPCa) in men with elevated PSA values before biopsy. This study aimed to calculate a multivariable risk model incorporating standard risk factors and mpMRI findings for predicting csPCa on subsequent prostate biopsy. METHODS Data from 677 patients undergoing mpMRI ultrasound fusion biopsy of the prostate at the TUM University Hospital tertiary urological center between 2019 and 2023 were analyzed. Patient age at biopsy (67 (median); 33-88 (range) (years)), PSA (7.2; 0.3-439 (ng/ml)), prostate volume (45; 10-300 (ml)), PSA density (0.15; 0.01-8.4), PI-RADS (V.2.0 protocol) score of index lesion (92.2% ≥3), prior negative biopsy (12.9%), suspicious digital rectal examination (31.2%), biopsy cores taken (12; 2-22), and pathological biopsy outcome were analyzed with multivariable logistic regression for independent associations with the detection of csPCa defined as ISUP ≥ 3 (n = 212 (35.2%)) and ISUP ≥ 2 (n = 459 (67.8%) performed on 603 patients with complete information. RESULTS Older age (OR: 1.64 for a 10-year increase; p < 0.001), higher PSA density (OR: 1.60 for a doubling; p < 0.001), higher PI-RADS score of the index lesion (OR: 2.35 for an increase of 1; p < 0.001), and a prior negative biopsy (OR: 0.43; p = 0.01) were associated with csPCa. CONCLUSION mpMRI findings are the dominant predictor for csPCa on follow-up prostate biopsy. However, PSA density, age, and prior negative biopsy history are independent predictors. They must be considered when discussing the individual risk for csPCa following suspicious mpMRI and may help facilitate the further diagnostical approach.
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Affiliation(s)
- Matthias Jahnen
- Department of Urology, School of Medicine and Health, Technical University of Munich (TUM) Rechts der Isar University Hospital, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Tanja Hausler
- Department of Mathematics, School of Computation, Information, and Technology, Boltzmannstr. 3, 85748, Garching, Germany
| | - Valentin H Meissner
- Department of Urology, School of Medicine and Health, Technical University of Munich (TUM) Rechts der Isar University Hospital, Ismaningerstr. 22, 81675, Munich, Germany
| | - Donna P Ankerst
- Department of Mathematics, School of Computation, Information, and Technology, Boltzmannstr. 3, 85748, Garching, Germany
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich (TUM) Rechts der Isar University Hospital, Ismaningerstr. 22, 81675, Munich, Germany
| | - Juergen E Gschwend
- Department of Urology, School of Medicine and Health, Technical University of Munich (TUM) Rechts der Isar University Hospital, Ismaningerstr. 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, School of Medicine and Health, Technical University of Munich (TUM) Rechts der Isar University Hospital, Ismaningerstr. 22, 81675, Munich, Germany
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Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, García-de Manuel G, Miró B, Abascal JM, Servian P. The Role of Digital Rectal Examination Prostate Volume Category in the Early Detection of Prostate Cancer: Its Correlation with the Magnetic Resonance Imaging Prostate Volume. World J Mens Health 2024; 42:441-448. [PMID: 38164025 PMCID: PMC10949025 DOI: 10.5534/wjmh.230028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To relate the prostate volume category (PVC) assessed with digital rectal examination (DRE)-small, median, and large-and the prostate volumes (PVs) assessed with magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS). To compare the clinically significant prostate cancer (csPCa) discrimination ability of two predictive models based on DRE-PVC and MRI-PV. MATERIALS AND METHODS A prospective trial of 2,090 men with prostate-specific antigen >3 ng/mL and/or PCa suspicious DRE were prospectively recruited in 10 centers from Catalonia (Spain), between 2021 and 2022, in whom DRE-PVC was assessed. Pre-biopsy MRI, and 12-core TRUS-random biopsy was always performed after 2- to 6-core TRUS-fusion targeted biopsy of prostate imaging-report and data system >3 lesions. In 370 men (17.7%) the DRE-PVC was unconclusive. Among the 1,720 men finally analyzed the csPCa (grade group >2) detection was 42.4%. RESULTS The median (interquartile range) of TRUS and MRI-PVs of small prostates were 33 mL (19-37 mL) and 35 mL (23-30 mL), p=0.410; in median prostates they were 51 mL (38-58 mL) and 55 mL (48-63 mL) respectively, p<0.001; in large prostates 80 mL (60-100 mL) and 95 mL (75-118 mL) respectively, p<0.001. The predictive models sharing the MRI-PV and DRE-PVC showed areas under the curves of 0.832 (95% confidence interval [CI], 0.813-0.851) and 0.828 (95% CI, 0.809-0.848) respectively, p=0.632, as well as similar net benefit and clinical utility. CONCLUSIONS PVC was unconclusive in 17% of DREs. MRI-PV overestimated the TRUS-PV in median and large prostates. The predictive models based on MRI-PV and DRE-PVC showed similar efficacy to predict csPCa. PVC assessed with DRE is helpful to predict the csPCa risk before MRI.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Xavier Ruiz-Plazas
- Department of Urology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Ana Celma
- Department of Urology, Vall d'Hebron Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Berta Miró
- Unit of Statistics and Bioinformatics, Vall d'Hebron Reseach Institute, Badalona, Spain
| | - José M Abascal
- Department of Urology, Parc de Salut Mar, Badalona, Spain
| | - Pol Servian
- Department of Surgery, Universitat Pompeu Fabra, Badalona, Spain
- Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain
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Morote J, Borque-Fernando Á, Esteban LE, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, García-de Manuel G, Miró B, Abascal JM, Servian P. Reducing the demand for magnetic resonance imaging scans and prostate biopsies during the early detection of clinically significant prostate cancer: Applying the Barcelona risk-stratified pathway in Catalonia. Urol Oncol 2024; 42:115.e1-115.e7. [PMID: 38342654 DOI: 10.1016/j.urolonc.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE To analyze the reduction in multiparametric magnetic resonance imaging (mpMRI) demand and prostate biopsies after the hypothetical implementation of the Barcelona risk-stratified pathway (BCN-RSP) in a population of the clinically significant prostate cancer (csCaP) early detection program in Catalonia. MATERIALS AND METHODS A retrospective comparation between the hypothetical application of the BCN-RSP and the current pathway, which relied on pre-biopsy mpMRI and targeted and/or systematic biopsies, was conducted. The BCN-RSP stratify men with suspected CaP based on a prostate specific antigen (PSA) level >10 ng/ml and a suspicious rectal examination (DRE), and the Barcelona-risk calculator 1 (BCN-RC1) to avoid mpMRI scans. Subsequently, candidates for prostate biopsy following mpMRI are selected based on the BCN-RC2. This comparison involved 3,557 men with serum PSA levels > 3.0 ng/ml and/or suspicious DRE. The population was recruited prospectively in 10 centers from January 2021 and December 2022. CsCaP was defined when grade group ≥ 2. RESULTS CsCaP was detected in 1,249 men (35.1%) and insignificant CaP was overdeteced in 498 (14%). The BCN-RSP would have avoid 705 mpMRI scans (19.8%), and 697 prostate biopsies (19.6%), while 61 csCaP (4.9%) would have been undetected. The overdetection of insignificant CaP would have decrease in 130 cases (26.1%), and the performance of prostate biopsy for csCaP detection would have increase to 41.5%. CONCLUSION The application of the BCN-RSP would reduce the demand for mpMRI scans and prostate biopsies by one fifth while less than 5% of csCaP would remain undetected. The overdetection of insignificant CaP would decrease by more than one quarter and the performance of prostate biopsy for csCaP detection would increase to higher than 40%.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d´Hebron Hospital, and Department of Surgery, Universitat Autònoma de Barcelona, Barcelona Spain.
| | | | - Luis E Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, Universidad de Zaragoza, Zaragoza, Spain
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | - Xavier Ruiz-Plazas
- Department of Urology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Anna Celma
- Department of Urology, Vall d´Hebron Hospital, and Department of Surgery, Universitat Autònoma de Barcelona, Barcelona Spain
| | | | - Berta Miró
- Unit of Statistics and Bioinformatics. Vall d´Hebron Reseach Institute, Barcelona, Spain
| | - José M Abascal
- Department of Urology, Parc de Salut Mar, and Department of Surgery, Universitat Pompeu Fabra, Barcelona, Spain
| | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain
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Davik P, Remmers S, Elschot M, Roobol MJ, Bathen TF, Bertilsson H. Performance of magnetic resonance imaging-based prostate cancer risk calculators and decision strategies in two large European medical centres. BJU Int 2024; 133:278-288. [PMID: 37607322 DOI: 10.1111/bju.16163] [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] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To compare the performance of currently available biopsy decision support tools incorporating magnetic resonance imaging (MRI) findings in predicting clinically significant prostate cancer (csPCa). PATIENTS AND METHODS We retrospectively included men who underwent prostate MRI and subsequent targeted and/or systematic prostate biopsies in two large European centres. Available decision support tools were identified by a PubMed search. Performance was assessed by calibration, discrimination, decision curve analysis (DCA) and numbers of biopsies avoided vs csPCa cases missed, before and after recalibration, at risk thresholds of 5%-20%. RESULTS A total of 940 men were included, 507 (54%) had csPCa. The median (interquartile range) age, prostate-specific antigen (PSA) level, and PSA density (PSAD) were 68 (63-72) years, 9 (7-15) ng/mL, and 0.20 (0.13-0.32) ng/mL2 , respectively. In all, 18 multivariable risk calculators (MRI-RCs) and dichotomous biopsy decision strategies based on MRI findings and PSAD thresholds were assessed. The Van Leeuwen model and the Rotterdam Prostate Cancer Risk Calculator (RPCRC) had the best discriminative ability (area under the receiver operating characteristic curve 0.86) of the MRI-RCs that could be assessed in the whole cohort. DCA showed the highest clinical utility for the Van Leeuwen model, followed by the RPCRC. At the 10% threshold the Van Leeuwen model would avoid 22% of biopsies, missing 1.8% of csPCa, whilst the RPCRC would avoid 20% of biopsies, missing 2.6% of csPCas. These multivariable models outperformed all dichotomous decision strategies based only on MRI-findings and PSAD. CONCLUSIONS Even in this high-risk cohort, biopsy decision support tools would avoid many prostate biopsies, whilst missing very few csPCa cases. The Van Leeuwen model had the highest clinical utility, followed by the RPCRC. These multivariable MRI-RCs outperformed and should be favoured over decision strategies based only on MRI and PSAD.
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Affiliation(s)
- Petter Davik
- Department of Urology, St Olavs Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mattijs Elschot
- Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging (ISB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tone Frost Bathen
- Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim, Norway
| | - Helena Bertilsson
- Department of Urology, St Olavs Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Morote J, Borque-Fernando Á, Esteban LM, Celma A, Campistol M, Miró B, Méndez O, Trilla E. Investigating Efficient Risk-Stratified Pathways for the Early Detection of Clinically Significant Prostate Cancer. J Pers Med 2024; 14:130. [PMID: 38392564 PMCID: PMC10890536 DOI: 10.3390/jpm14020130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Risk-stratified pathways (RSPs) are recommended by the European Association of Uro-logy (EAU) to improve the early detection of clinically significant prostate cancer (csPCa). RSPs can reduce magnetic resonance imaging (MRI) demand, prostate biopsies, and the over-detection of insignificant PCa (iPCa). Our goal is to analyze the efficacy and cost-effectiveness of several RSPs by using sequential stratifications from the serum prostate-specific antigen level and digital rectal examination, the Barcelona risk calculators (BCN-RCs), MRI, and Proclarix™. In a cohort of 567 men with a serum PSA level above 3.0 ng/mL who underwent multiparametric MRI (mpMRI) and targeted and/or systematic biopsies, the risk of csPCa was retrospectively assessed using Proclarix™ and BCN-RCs 1 and 2. Six RSPs were compared with those recommended by the EAU that, stratifying men from MRI, avoided 16.7% of prostate biopsies with a prostate imaging-reporting and data system score of <3, with 2.6% of csPCa cases remaining undetected. The most effective RSP avoided mpMRI exams in men with a serum PSA level of >10 ng/mL and suspicious DRE, following stratifications from BCN-RC 1, mpMRI, and Proclarix™. The demand for mpMRI decreased by 19.9%, prostate biopsies by 19.8%, and over-detection of iPCa by 22.7%, while 2.6% of csPCa remained undetected as in the recommended RSP. Cost-effectiveness remained when the Proclarix™ price was assumed to be below EUR 200.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Research Group in Urology, Vall d'Hebron Research Institute, 08035 Barcelona, Spain
| | | | - Luis M Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, Universidad de Zaragoza, 50100 Zaragoza, Spain
| | - Ana Celma
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Research Group in Urology, Vall d'Hebron Research Institute, 08035 Barcelona, Spain
| | - Miriam Campistol
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Berta Miró
- Statistic Unit, Vall d'Hebron Research Institute, 08035 Barcelona, Spain
| | - Olga Méndez
- Research Group in Urology, Vall d'Hebron Research Institute, 08035 Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Research Group in Urology, Vall d'Hebron Research Institute, 08035 Barcelona, Spain
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Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, Manuel GGD, Aisian I, Servian P, Abascal JM. A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies. Cancers (Basel) 2023; 15:4543. [PMID: 37760511 PMCID: PMC10526349 DOI: 10.3390/cancers15184543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/16/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721-0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, 08907 Hospitalet de Llobregat, Spain;
| | | | | | - Xavier Ruiz-Plazas
- Department of Urology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain;
| | | | - Anna Celma
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | | | - Ignacio Aisian
- Department of Urology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - José M. Abascal
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain;
- Department of Medicine and Health Science, Universitat Pompeu Fabra, 08003 Barcelona, Spain
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Morote J, Borque‐Fernando Á, Triquell M, Abascal JM, Servian P, Planas J, Mendez O, Esteban LM, Tilla E. A risk-organised model for clinically significant prostate cancer early detection. BJUI COMPASS 2023; 4:420-422. [PMID: 37334020 PMCID: PMC10268578 DOI: 10.1002/bco2.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- Juan Morote
- Department of UrologyVall d'Hebron HospitalBarcelonaSpain
- Department of SurgeryUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of UrologyHospital Miguel Servet, IIS‐AragonZaragozaSpain
| | | | - Marina Triquell
- Department of UrologyVall d'Hebron HospitalBarcelonaSpain
- Department of SurgeryUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - José M. Abascal
- Department of UrologyParc de Salut MarBarcelonaSpain
- Department of SurgeryUniversitat Pompeu FabraBarcelonaSpain
| | - Pol Servian
- Department of UrologyHospital Germans Trias i PujolBadalonaSpain
| | - Jacques Planas
- Department of UrologyVall d'Hebron HospitalBarcelonaSpain
- Department of SurgeryUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Olga Mendez
- Urology Biomedical Research UnitVall d'Hebron Research InstituteBarcelonaSpain
| | - Luis M. Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La AlmuniaUniversidad de ZaragozaZaragozaSpain
| | - Enrique Tilla
- Department of UrologyVall d'Hebron HospitalBarcelonaSpain
- Department of SurgeryUniversitat Autònoma de BarcelonaBarcelonaSpain
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Morote J, Picola N, Paesano N, Celma A, Muñoz-Rodriguez J, Asiain I, Ruiz-Plazas X, Muñoz-Rivero MV, de Manuel GG, Servian P, Abascal JM. Are magnetic resonance imaging and targeted biopsies needed in men with serum prostate-specific antigen over 10 ng/ml and an abnormal digital rectal examination? Urol Oncol 2023; 41:299-301. [PMID: 37244767 DOI: 10.1016/j.urolonc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/29/2023]
Abstract
The European Association of Urology currently recommends the use of risk-organized models to decrease the demand of prebiopsy magnetic resonance imaging (MRI) and unnecessary prostate biopsies in men with suspected prostate cancer (CaP). Low evidence suggests that men with prostate-specific antigen >10 ng/ml and an abnormal digital rectal examination (DRE) do not benefit from prebiopsy MRI and targeted biopsies. We aim to validate this low evidence in a sizable cohort and knowing how many clinically significant CaP (csCaP) would go undetected if only random biopsies were performed in these cases. We analyze a subset of 545 men with PSA >10 ng/ml and an abnormal DRE who met the previous criteria among 5,329 participants in a prospective trial in whom random biopsy was always performed and targeted biopsies of PI-RADS ≥3 lesions (10.2%). CsCaP (grade group ≥2) was detected in 370 men (67.9%), with 11 of 49 with negative MRI (22.5%) and 359 of 496 (72.4%) having PI-RADS ≥3. CsCaP was identified in random and targeted biopsies in 317 (88.7%) men, in targeted biopsies only in 23 (6.4%), and in random biopsies only in 19 (5.3%). If only random biopsies were performed in these men, 23 of overall 1,914 csCaP (1.2%) would go undetected in this population. Prebiopsy MRI can be saved in men with serum PSA >10 ng/ml and an abnormal DRE and only random biopsy performed. However, a close follow-up of men with negative random biopsy seems appropriate due to the high-risk of csCaP in these men.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d'Hebron Hospital, and Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | - Anna Celma
- Department of Urology, Vall d'Hebron Hospital, and Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Ignacio Asiain
- Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Xavier Ruiz-Plazas
- Deparment of Utology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - José M Abascal
- Department of Urology, Parc de Salut Mar, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Morote J, Borque-Fernando Á, Triquell M, Campistol M, Servian P, Abascal JM, Planas J, Méndez O, Esteban LM, Trilla E. Comparison of Rotterdam and Barcelona Magnetic Resonance Imaging Risk Calculators for Predicting Clinically Significant Prostate Cancer. EUR UROL SUPPL 2023; 53:46-54. [PMID: 37441350 PMCID: PMC10334241 DOI: 10.1016/j.euros.2023.03.013] [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] [Accepted: 03/19/2023] [Indexed: 07/15/2023] Open
Abstract
Background Magnetic resonance imaging (MRI)-based risk calculators (MRI-RCs) individualise the likelihood of clinically significant prostate cancer (csPCa) and improve candidate selection for prostate biopsy beyond the Prostate Imaging Reporting and Data System (PI-RADS). Objective To compare the Barcelona (BCN) and Rotterdam (ROT) MRI-RCs in an entire population and according to the PI-RADS categories. Design setting and participants A prospective comparison of BCN- and ROT-RC in 946 men with suspected prostate cancer in whom systematic biopsy was performed, as well as target biopsies of PI-RADS ≥3 lesions. Outcome measurements and statistical analysis Saved biopsies and undetected csPCa (grade group ≥2) were determined. Results and limitations The csPCa detection was 40.8%. The median risks of csPCa from BCN- and ROT-RC were, respectively, 67.1% and 25% in men with csPCa, whereas 10.5% and 3% in those without csPCa (p < 0.001). The areas under the curve were 0.856 and 0.844, respectively (p = 0.116). BCN-RC showed a higher net benefit and clinical utility over ROT-RC. Using appropriate thresholds, respectively, 75% and 80% of biopsies were needed to identify 50% of csPCa detected in men with PI-RADS <3, whereas 35% and 21% of biopsies were saved, missing 10% of csPCa detected in men with PI-RADS 3. BCN-RC saved 15% of biopsies, missing 2% of csPCa in men with PI-RADS 4, whereas ROT-RC saved 10%, missing 6%. No RC saved biopsies without missing csPCa in men with PI-RADS 5. Conclusions ROT-RC provided a lower and narrower range of csPCa probabilities than BCN-RC. BCN-RC showed a net benefit over ROT-RC in the entire population. However, BCN-RC was useful in men with PI-RADS 3 and 4, whereas ROT-RC was useful only in those with PI-RADS 3. No RC seemed to be helpful in men with negative MRI and PI-RADS 5. Patient summary Barcelona risk calculator was more helpful than Rotterdam risk calculator to select candidates for prostate biopsy.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d́Hebron Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Marina Triquell
- Department of Urology, Vall d́Hebron Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miriam Campistol
- Department of Urology, Vall d́Hebron Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pol Servian
- Department of Urology, Hospital Germans Trias I Pujol, Badalona, Spain
| | - José M. Abascal
- Department of Urology, Parc de Salut Mar, Barcelona, Spain
- Department of Surgery, Universitat Pompeu Fabra, Badalona, Spain
| | - Jacques Planas
- Department of Urology, Vall d́Hebron Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Olga Méndez
- Biomedical Research in Urology Unit, Vall d́Hebron Research Institute, Barcelona, Spain
| | - Luis M. Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, Universidad de Zaragoza, Zaragoza, Spain
| | - Enrique Trilla
- Department of Urology, Vall d́Hebron Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
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11
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Morote J. Re: Jonas Hugosson, Marianne Månsson, Jona Wallström, et al. Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only. N Engl J Med 2022;387:2126-37. Eur Urol Oncol 2023; 6:234. [PMID: 36894492 DOI: 10.1016/j.euo.2023.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Juan Morote
- Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
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12
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A Clinically Significant Prostate Cancer Predictive Model Using Digital Rectal Examination Prostate Volume Category to Stratify Initial Prostate Cancer Suspicion and Reduce Magnetic Resonance Imaging Demand. Cancers (Basel) 2022; 14:cancers14205100. [PMID: 36291883 PMCID: PMC9600141 DOI: 10.3390/cancers14205100] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
A predictive model including age, PCa family history, biopsy status (initial vs repeat), DRE (normal vs abnormal), serum prostate-specific antigen (PSA), and DRE prostate volume ca-tegory was developed to stratify initial PCa suspicion in 1486 men with PSA > 3 ng/mL and/or abnormal DRE, in whom mpMRI followed; 2- to 4-core TRUS-guided biopsies where Prostate Imaging Report and Data System (PI-RADS) > 3 lesions and/or 12-core TRUS systematic biopsies were performed in one academic institution between 1 January 2016−31 December 2019. The csPCa detection rate, defined as International Society of Uro-Pathology grade group 2 or higher, was 36.9%. An external validation of designed BCN-RC 1 was carried out on 946 men from two other institutions in the same metropolitan area, using the same criteria of PCa suspicion and diagnostic approach, yielded a csPCa detection rate of 40.8%. The areas under the receiver operating characteristic curves of BCN-RC 1 were 0.823 (95% CI: 0.800−0.846) in the development cohort and 0.837 (95% CI: 0.811−0.863) in the validation cohort (p = 0.447). In both cohorts, BCN-RC 1 exhibited net benefit over performing mpMRI in all men from 8 and 12% risk thresholds, respectively. At 0.95 sensitivity of csPCa, the specificities of BCN-RC 1 were 0.24 (95% CI: 0.22−0.26) in the development cohort and 0.34 (95% CI: 0.31−0.37) in the validation cohort (p < 0.001). The percentages of avoided mpMRI scans were 17.2% in the development cohort and 22.3% in the validation cohort, missing between 1.8% and 2% of csPCa among men at risk of PCa. In summary, BCN-RC 1 can stratify initial PCa suspicion, reducing the demand of mpMRI, with an acceptable loss of csPCa.
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Magnetic Resonance Imaging-Based Predictive Models for Clinically Significant Prostate Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14194747. [PMID: 36230670 PMCID: PMC9562712 DOI: 10.3390/cancers14194747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Magnetic resonance imaging (MRI) has allowed the early detection of PCa to evolve towards clinically significant PCa (csPCa), decreasing unnecessary prostate biopsies and overdetection of insignificant tumours. MRI identifies suspicious lesions of csPCa, predicting the semi-quantitative risk through the prostate imaging report and data system (PI-RADS), and enables guided biopsies, increasing the sensitivity of csPCa. Predictive models that individualise the risk of csPCa have also evolved adding PI-RADS score (MRI-PMs), improving the selection of candidates for prostate biopsy beyond the PI-RADS category. During the last five years, many MRI-PMs have been developed. Our objective is to analyse the current developed MRI-PMs and define their clinical usefulness through a systematic review. We have found high heterogeneity between MRI technique, PI-RADS versions, biopsy schemes and approaches, and csPCa definitions. MRI-PMs outperform the selection of candidates for prostate biopsy beyond MRI alone and PMs based on clinical predictors. However, few developed MRI-PMs are externally validated or have available risk calculators (RCs), which constitute the appropriate requirements used in routine clinical practice. Abstract MRI can identify suspicious lesions, providing the semi-quantitative risk of csPCa through the Prostate Imaging-Report and Data System (PI-RADS). Predictive models of clinical variables that individualise the risk of csPCa have been developed by adding PI-RADS score (MRI-PMs). Our objective is to analyse the current developed MRI-PMs and define their clinical usefulness. A systematic review was performed after a literature search performed by two independent investigators in PubMed, Cochrane, and Web of Science databases, with the Medical Subjects Headings (MESH): predictive model, nomogram, risk model, magnetic resonance imaging, PI-RADS, prostate cancer, and prostate biopsy. This review was made following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and studied eligibility based on the Participants, Intervention, Comparator, and Outcomes (PICO) strategy. Among 723 initial identified registers, 18 studies were finally selected. Warp analysis of selected studies was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Clinical predictors in addition to the PI-RADS score in developed MRI-PMs were age, PCa family history, digital rectal examination, biopsy status (initial vs. repeat), ethnicity, serum PSA, prostate volume measured by MRI, or calculated PSA density. All MRI-PMs improved the prediction of csPCa made by clinical predictors or imaging alone and achieved most areas under the curve between 0.78 and 0.92. Among 18 developed MRI-PMs, 7 had any external validation, and two RCs were available. The updated PI-RADS version 2 was exclusively used in 11 MRI-PMs. The performance of MRI-PMs according to PI-RADS was only analysed in a single study. We conclude that MRI-PMs improve the selection of candidates for prostate biopsy beyond the PI-RADS category. However, few developed MRI-PMs meet the appropriate requirements in routine clinical practice.
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Morote J, Borque-Fernando Á, Triquell M, Esteban LM, Trilla E. The True Utility of Predictive Models Based on Magnetic Resonance Imaging in Selecting Candidates for Prostate Biopsy. EUR UROL SUPPL 2022; 42:40-41. [PMID: 35795075 PMCID: PMC9251714 DOI: 10.1016/j.euros.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
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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.
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