A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population

Abstract

This study aimed to develop and validate a predictive model for the assessment of clinically significant prostate cancer (csPCa) in men, prior to prostate biopsies, based on bi-parametric magnetic resonance imaging (bpMRI) and clinical parameters. Materials and MethodsWe retrospectively analyzed 300 men with clinical suspicion of prostate cancer (prostatespecific antigen [PSA] ≥ 4.0 ng/mL and/or abnormal findings in a digital rectal examination [DRE]), who underwent bpMRI-ultrasound fusion transperineal targeted and systematic biopsies (bpMRI-US transperineal FTSB) in the same session, at a Korean university hospital. Predictive models, based on Prostate Imaging Reporting and Data Systems (PI-RADS) scores of bpMRI and clinical parameters, were developed to detect csPCa (intermediate/high grade [GS ≥ 3 + 4]) and compared by analyzing the areas under the curves and decision curves. ResultsA predictive model defined by the combination of bpMRI and clinical parameters (age, PSA density) showed high discriminatory power (area under the curve, 0.861) and resulted in a significant net benefit on decision curve analysis. Applying a probability threshold of 7.5%, 21.6% of men could avoid unnecessary prostate biopsy, while only 1.0% of significant prostate cancers were missed. ConclusionThis predictive model provided a reliable and measurable means of risk stratification of csPCa, with high discriminatory power and great net benefit. It could be a useful tool for clinical decision-making prior to prostate biopsies.

Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study

“…Previously, we have reported a protocol for this procedure as well as a risk stratification model for clinically significant PCa. 19 , 20 Briefly, we performed biparametric MRI using a 3.0-T scanner (Siemens Medical System, Erlangen, Germany), and prostate imaging reporting and data systems (PI-RADS) scores were assigned by uroradiologists according to PI-RADS version 2.0. Patients who were diagnosed with clinically significant PCa (Gleason score ≥7 [3 + 4]) by targeted biopsy or patients in whom suspected extracapsular extension was identified on MRI did not undergo planned nsRARP.…”

Abbreviated MRI Protocols in the Abdomen and Pelvis

“…Other studies have examined the combination of bp‐MRI and clinical parameters (eg, age and PSA density) and have found improved performance for these combinations over mp‐MRI alone 79,80 . However, in another study PSA density was not shown to have incremental benefit to bp‐MRI alone 81 …”

Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy

“…However, few MRI-PMs have been developed from the latest versions of PI-RADS; furthermore, external validation should be performed before their use. Easily accessible risk calculators (RCs) are essential for avoiding nomograms, which are cumbersome and time-consuming [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Recently, the Barcelona MRI-PM was developed from the following independent predictors: PI-RADS score v.2.0, age, serum PSA, DRE, PCa family history, type of biopsy (initial vs. repeat), and MRI-derived prostate volume.…”