Objective
To develop nomograms that predict the probability of overall prostate cancer (PCa)
and clinically significant PCa (Gleason ≥7) on magnetic resonance imaging (MRI)-targeted,
and combined MRI-targeted and systematic, prostate biopsy.
Materials and Methods
From June 2012 to August 2014, magnetic resonance imaging to ultrasound fusion-targeted
prostate biopsy was performed on 464 men with suspicious regions identified on pre-biopsy
3T MRI along with systematic 12 core biopsy. Logistic regression modeling was used
to evaluate predictors of overall and clinically significant PCa, and corresponding
nomograms were generated for men who were not previously biopsied or had 1 or more
prior negative biopsies. Models were created with 70% of a randomly selected training
sample and bias-corrected using bootstrap resampling. The models were then validated
with the remaining 30% testing sample pool.
Results
A total of 459 patients were included for analysis (median age 66 years, prostate-specific
antigen [PSA] 5.2 ng/mL, prostate volume 49 cc). Independent predictors of PCa on
targeted and systematic prostate biopsy were PSA density, age, and MRI suspicion score.
PCa probability nomograms were generated for each cohort using the predictors. Bias-corrected
areas under the receiver-operating characteristic curves for overall and clinically
significant PCa detection were 0.82 (0.78) and 0.91 (0.84) for men without prior biopsy
and 0.76 (0.65) and 0.86 (0.87) for men with a prior negative biopsy in the training
(testing) samples.
Conclusion
PSA density, age, and MRI suspicion score predict PCa on combined MRI-targeted and
systematic biopsy. Our generated nomograms demonstrate high diagnostic accuracy and
may further aid in the decision to perform biopsy in men with clinical suspicion of
PCa.
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Article info
Publication history
Published online: November 16, 2017
Accepted:
September 14,
2017
Received:
February 3,
2017
Footnotes
Financial Disclosure: Andrew B. Rosenkrantz receives royalties from Thieme Medical Publishers for textbook editing. Herbert Lepor is co-owner of MedReviews and works as speaker (Speaker Bureau) at Allergan, investor at Serenity and Sonacare, and consultant at Thera Coat and Biozeus. Samir S. Taneja works as consultant at Biobot and is scientific study/investigator at Trod Medical. Marc A. Bjurlin is a speaker for Blue Earth Diagnostics. The remaining authors declare that they have no relevant financial interests.
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© 2017 Elsevier Inc. All rights reserved.
