Objective
To determine the added value of prostate magnetic resonance imaging (MRI) to the Prostate
Cancer Prevention Trial risk calculator.
Methods
Between January 2012 and December 2015, 339 patients underwent prostate MRI prior
to biopsy at our institution. MRI was considered positive if there was at least 1
Prostate Imaging Reporting and Data System 4 or 5 MRI suspicious region. Logistic
regression was used to develop 2 models: biopsy outcome as a function of the (1) Prostate
Cancer Prevention Trial risk calculator alone and (2) combined with MRI findings.
Results
When including all patients, the Prostate Cancer Prevention Trial with and without
MRI models performed similarly (area under the curve [AUC] = 0.74 and 0.78, P = .06). When restricting the cohort to patients with estimated risk of high-grade
(Gleason ≥7) prostate cancer ≤10%, the model with MRI outperformed the Prostate Cancer
Prevention Trial alone model (AUC = 0.69 and 0.60, P = .01). Within this cohort of patients, there was no significant difference in discrimination
between models for those with previous negative biopsy (AUC = 0.61 vs 0.63, P = .76), whereas there was a significant improvement in discrimination with the MRI
model for biopsy-naïve patients (AUC = 0.72 vs 0.60, P = .01).
Conclusion
The use of prostate MRI in addition to the Prostate Cancer Prevention Trial risk calculator
provides a significant improvement in clinical risk discrimination for patients with
estimated risk of high-grade (Gleason ≥7) prostate cancer ≤10%. Prebiopsy prostate
MRI should be strongly considered for these patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature.Eur Urol. 2015; 68: 1045-1053
- Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis.Eur Urol. 2015; 68: 438-450
- Detection of clinically significant prostate cancer using magnetic resonance imaging-ultrasound fusion targeted biopsy: a systematic review.Eur Urol. 2015; 68: 8-19
- Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer.JAMA. 2015; 313: 390-397
- The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localization of prostate abnormalities for biopsy: a systematic review and economic evaluation.Health Technol Assess. 2013; 17: 1-281
- Prostate-specific antigen-based screening: controversy and guidelines.BMC Med. 2015; 13: 1
- Do prostate cancer risk models improve the predictive accuracy of PSA screening? A meta-analysis.Ann Oncol. 2015; 26: 848-864
- Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer.Urology. 2014; 83: 1362-1368
- Diagnostic value of biparametric magnetic resonance imaging (MRI) as an adjunct to prostate-specific antigen (PSA)-based detection of prostate cancer in men without prior biopsies.BJU Int. 2015; 115: 381-388
- Multiparametric magnetic resonance imaging outperforms the Prostate Cancer Prevention Trial risk calculator in predicting clinically significant prostate cancer.Cancer. 2014; 120: 2876-2882
- Identification of threshold prostate specific antigen levels to optimize the detection of clinically significant prostate cancer by magnetic resonance imaging/ultrasound fusion guided biopsy.J Urol. 2014; 192: 1642-1649
- ESUR prostate MR guidelines.Eur Radiol. 2012; 22: 746-757
- PIRADS Version 2.(Available at:)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf(Accessed July 9)Date: 2016
- Head-to-head comparison if PI-RADS v2 and PI-RADS v1.Eur J Radiol. 2016; 85: 1125-1131
- Prostate cancer: PI-RADS version 2 helps preoperatively predict clinically significant cancers.Radiology. 2016; 280: 108-116
- Presence of magnetic resonance imaging suspicious lesion predicts Gleason 7 or greater prostate cancer in biopsy-naïve patients.Urology. 2016; 88: 119-124
- Magnetic resonance imaging-targeted vs. conventional transrectal ultrasound-guided prostate biopsy: single-institution, matched cohort comparison.Urol Oncol. 2015; 33 (e1-109.e6): 109
- The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system.Am J Surg Pathol. 2016; 40: 244-252
- Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study.J Urol. 2014; 192: 67-74
- Negative predictive value of multiparametric MRI for prostate cancer detection: outcome of 5-year follow-up in men with negative findings on initial MRI studies.Eur J Radiol. 2014; 83: 1740-1745
- Prebiopsy multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naïve men with suspected prostate cancer based on elevated prostate-specific antigen values: results from a randomized prospective blinded controlled trial.Eur Urol. 2016; 69: 419-425
- A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial.Eur Urol. 2014; 66: 343-351
- Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy-prospective multicenter study.Radiology. 2013; 268: 461-469
Article info
Publication history
Published online: December 02, 2016
Accepted:
August 30,
2016
Received:
June 6,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
