African American Men have Increased Risk of Prostate Cancer Detection Despite Similar Rates of Anterior Prostatic Lesions and PI-RADS Grade on Multiparametric Magnetic Resonance Imaging

Patel, Hiten D.; Doshi, Chirag; Koehne, Elizabeth L.; Hart, Spencer; Kuiken, Michelle Van; Quek, Marcus L.; Flanigan, Robert C.; Gupta, Gopal N.

doi:10.1016/j.urology.2021.07.005

Cited by 14 publications

(13 citation statements)

References 20 publications

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“…Other clinical factors, including age, a smaller prostate volume, and an abnormal digital rectal examination, have also been proposed as additional clinical factors that could improve the ability to detect CSPCa in men with PI‐RADS 3 lesions 14 . Our analysis is the first to confirm that the anterior lesion location remains an important predictor of cancer in PI‐RADS 3 lesions; this previously has been demonstrated only in cohorts with mixed PI‐RADS 3–5 lesions 19 . MRI findings, including a lower apparent diffusion coefficient (ADC; 800–1000 μm 2 /s), have also been associated with CSPCa 12, 20 .…”

Section: Discussionmentioning

confidence: 48%

Multi‐institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI‐RADS 3 lesions

Fang

Shumaker

Martin

et al. 2022

Cancer

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BACKGROUND: Most Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions do not contain clinically significant prostate cancer (CSPCa; grade group ≥2). This study was aimed at identifying clinical and magnetic resonance imaging (MRI)-derived risk factors that predict CSPCa in men with PI-RADS 3 lesions. METHODS: This study analyzed the detection of CSPCa in men who underwent MRI-targeted biopsy for PI-RADS 3 lesions. Multivariable logistic regression models with goodness-of-fit testing were used to identify variables associated with CSPCa. Receiver operating curves and decision curve analyses were used to estimate the clinical utility of a predictive model. RESULTS: Of the 1784 men reviewed, 1537 were included in the training cohort, and 247 were included in the validation cohort. The 309 men with CSPCa (17.3%) were older, had a higher prostate-specific antigen (PSA) density, and had a greater likelihood of an anteriorly located lesion than men without CSPCa (p < .01). Multivariable analysis revealed that PSA density (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.05-1.85; p < .01), age (OR, 1.05; 95% CI, 1.02-1.07; p < .01), and a biopsy-naive status (OR, 1.83; 95% CI, 1.38-2.44) were independently associated with CSPCa. A prior negative biopsy was negatively associated (OR, 0.35; 95% CI, 0.24-0.50; p < .01). The application of the model to the validation cohort resulted in an area under the curve of 0.78. A predicted risk threshold of 12% could have prevented 25% of biopsies while detecting almost 95% of CSPCas with a sensitivity of 94% and a specificity of 34%. CONCLUSIONS: For PI-RADS 3 lesions, an elevated PSA density, older age, and a biopsy-naive status were associated with CSPCa, whereas a prior negative biopsy was negatively associated. A predictive model could prevent PI-RADS 3 biopsies while missing few CSPCas.

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Section: Discussionmentioning

confidence: 48%

Multi‐institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI‐RADS 3 lesions

Fang

Shumaker

Martin

et al. 2022

Cancer

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“…A study from Loyola and UAB populations showed that Asian American men have a lower risk of PCa (OR = 0.15, 95% CI: 0.06-0.42) and CSPCa (OR = 0.34, 95% CI: 0.12-1.02) than other races (33). For men with African ancestry, Patel et al conducted a study evaluating implications of race (African American men versus non-African American men) and tumor location for PCa detection (34). The authors concluded that African American men did not find statistically significant difference in the number of lesions, number of anterior prostate lesions, or distribution of highest PI-RADS lesions but had a higher risk of PCa, which indicated that the risk of PCa in African American men cannot be explained simply by PI-RADS score distribution and tumor location (34).…”

Section: Discussionmentioning

confidence: 99%

“…For men with African ancestry, Patel et al conducted a study evaluating implications of race (African American men versus non-African American men) and tumor location for PCa detection (34). The authors concluded that African American men did not find statistically significant difference in the number of lesions, number of anterior prostate lesions, or distribution of highest PI-RADS lesions but had a higher risk of PCa, which indicated that the risk of PCa in African American men cannot be explained simply by PI-RADS score distribution and tumor location (34). Furthermore, the patients of this cohort were biopsy-naïve, and the biopsy setting could influence the performance of models.…”

Section: Discussionmentioning

confidence: 99%

Construction and Comparison of Different Models in Detecting Prostate Cancer and Clinically Significant Prostate Cancer

Zhou

Cui

et al. 2022

Front. Oncol.

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BackgroundWith the widespread adoption of prostatic-specific antigen (PSA) screening, the detection rates of prostate cancer (PCa) have increased. Due to the low specificity and high false-positive rate of serum PSA levels, it was difficult to diagnose PCa accurately. To improve the diagnosis of PCa and clinically significant prostate cancer (CSPCa), we established novel models on the basis of the prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) in the Asian population.MethodsWe retrospectively collected the clinical indicators of patients with TPSA at 4–20 ng/ml. Furthermore, mpMRI was performed using a 3.0-T scanner and reported in the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS). Univariable and multivariable logistic analyses were performed to construct the models. The performance of different models based on PSA derivatives, PHI derivatives, PI-RADS, and a combination of PHI derivatives and PI-RADS was evaluated.ResultsAmong the 128 patients, 47 (36.72%) patients were diagnosed with CSPCa and 81 (63.28%) patients were diagnosed with non-CSPCa. Of the 81 (63.28%) patients, 8 (6.25%) patients were diagnosed with Gleason Grade 1 PCa and 73 (57.03%) patients were diagnosed with non-PCa. In the analysis of the receiver operator characteristic (ROC) curves in TPSA 4–20 ng/ml, the multivariable model for PCa was significantly larger than that for the model based on the PI-RADS (p = 0.004) and that for the model based on the PHI derivatives (p = 0.031) in diagnostic accuracy. The multivariable model for CSPCa was significantly larger than that for the model based on the PI-RADS (p = 0.003) and was non-significantly larger than that for the model based on the PHI derivatives (p = 0.061) in diagnostic accuracy. For PCa in TPSA 4–20 ng/ml, a multivariable model achieved the optimal diagnostic value at four levels of predictive variables. For CSPCa in TPSA 4–20 ng/ml, the multivariable model achieved the optimal diagnostic value at a sensitivity close to 90% and 80%.ConclusionsThe models combining PHI derivatives and PI-RADS performed better in detecting PCa and CSPCa than the models based on either PHI or PI-RADS.

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“…While mpMRI has improved cancer detection, racial disparities still exist among those undergoing mpMRI-targeted biopsies. Patel et al analyzed a group containing 53 African-American men with PI-RADS 3 lesions [25]; amongst all PI-RADS lesions, African-Americans were 1.64 times more likely to be diagnosed with prostate cancer over their cohort of non-AA patients. While this study gives clinicians valuable insight into anterior lesions, increased prostate cancer risk was identified among all biopsies, and a delineated PI-RADS score analysis (specifically PI-RADS 3) between racial groups was not reported.…”

Section: Discussionmentioning

confidence: 99%

Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions

Natale

Koller

Greenberg

et al. 2021

Life

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The use of multi-parametric magnetic resonance imaging (mpMRI) in conjunction with the Prostate Imaging Reporting and Data System (PI-RADS) is standard practice in the diagnosis, surveillance, and staging of prostate cancer. The risk associated with lesions graded at a PI-RADS score of 3 is ambiguous. Further characterization of the risk associated with PI-RADS 3 lesions would be useful in guiding further work-up and intervention. This study aims to better characterize the utility of PI-RADS 3 and associated risk factors in detecting clinically significant prostate cancer. From a prospectively maintained IRB-approved dataset of all veterans undergoing mpMRI fusion biopsy at the Southeastern Louisiana Veterans Healthcare System, we identified a cohort of 230 PI-RADS 3 lesions from a dataset of 283 consecutive UroNav-guided biopsies in 263 patients from October 2017 to July 2020. Clinically significant prostate cancer (Gleason Grade ≥ 2) was detected in 18 of the biopsied PI-RADS 3 lesions, representing 7.8% of the overall sample. Based on binomial analysis, PSA densities of 0.15 or greater were predictive of clinically significant disease, as was PSA. The location of the lesion within the prostate was not shown to be a statistically significant predictor of prostate cancer overall (p = 0.87), or of clinically significant disease (p = 0.16). The majority of PI-RADS 3 lesions do not represent clinically significant disease; therefore, it is possible to reduce morbidity through biopsy. PSA density is a potential adjunctive factor in deciding which patients with PI-RADS 3 lesions require biopsy. Furthermore, while the risk of prostate cancer for African-American men has been debated in the literature, our findings indicate that race is not predictive of identifying prostate cancer, with comparable Gleason grade distributions on histology between races.

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African American Men have Increased Risk of Prostate Cancer Detection Despite Similar Rates of Anterior Prostatic Lesions and PI-RADS Grade on Multiparametric Magnetic Resonance Imaging

Cited by 14 publications

References 20 publications

Multi‐institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI‐RADS 3 lesions

Multi‐institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI‐RADS 3 lesions

Construction and Comparison of Different Models in Detecting Prostate Cancer and Clinically Significant Prostate Cancer

Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions

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