Can we rely on a negative multiparametric MRI to exclude significant prostate cancer at biopsy? Results from a regional cancer centre

Lobo, Niyati; Petrides, Neophytos; Stanowski, M.; Morrison, I. D.; Thomas, Matthew B.; Kommu, Sashi S.; Streeter, E.; Eddy, B.

doi:10.1016/s1569-9056(19)31359-4

Cited by 2 publications

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“…At the same level of sensitivity (90%) in the prediction of suspicious MRI-PCa, the multivariate model could reduce more mpMRI scans (27%) and missed less CSPCa (1%), compared with PSAD (20% and 4%) and tPSA (16% and 4%). Reported proportions of the total negative MRI (PI-RADS 1-2) ranged from 37% to 58% for individual studies depending on the prevalence of PCa in the study populations (21)(22)(23). The ratios of negative MRI-PCa and equivocal MRI-PCa were 38% and 17% in our study.…”

Section: Discussionmentioning

confidence: 62%

Developing Strategy to Predict the Results of Prostate Multiparametric Magnetic Resonance Imaging and Reduce Unnecessary Multiparametric Magnetic Resonance Imaging Scan

Liu

Dong

et al. 2021

Front. Oncol.

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PurposeThe clinical utility of multiparametric magnetic resonance imaging (mpMRI) for the detection and localization of prostate cancer (PCa) has been evaluated and validated. However, the implementation of mpMRI into the clinical practice remains some burden of cost and availability for patients and society. We aimed to predict the results of prostate mpMRI using the clinical parameters and multivariable model to reduce unnecessary mpMRI scans.MethodsWe retrospectively identified 784 men who underwent mpMRI scans and subsequent prostate biopsy between 2016 and 2020 according to the inclusion criterion. The cohort was split into a training cohort of 548 (70%) patients and a validation cohort of 236 (30%) patients. Clinical parameters including age, prostate-specific antigen (PSA) derivates, and prostate volume (PV) were assessed as the predictors of mpMRI results. The mpMRI results were divided into groups according to the reports: “negative”, “equivocal”, and “suspicious” for the presence of PCa.ResultsUnivariate analysis showed that the total PSA (tPSA), free PSA (fPSA), PV, and PSA density (PSAD) were significant predictors for suspicious mpMRI (P < 0.05). The PSAD (AUC = 0.77) and tPSA (AUC = 0.74) outperformed fPSA (AUC = 0.68) and PV (AUC = 0.62) in the prediction of the mpMRI results. The multivariate model (AUC = 0.80) had a similar diagnostic accuracy with PSAD (P = 0.108), while higher than tPSA (P = 0.024) in predicting the mpMRI results. The multivariate model illustrated a better calibration and substantial improvement in the decision curve analysis (DCA) at a threshold above 20%. Using the PSAD with a 0.13 ng/ml2 cut-off could spare the number of mpMRI scans by 20%, keeping a 90% sensitivity in the prediction of suspicious MRI-PCa and missing three (3/73, 4%) clinically significant PCa cases. At the same sensitivity level, the multivariate model with a 32% cut-off could spare the number of mpMRI scans by 27%, missing only one (1/73, 1%) clinically significant PCa case.ConclusionOur multivariate model could reduce the number of unnecessary mpMRI scans without comprising the diagnostic ability of clinically significant PCa. Further prospective validation is required.

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Section: Discussionmentioning

confidence: 62%

Developing Strategy to Predict the Results of Prostate Multiparametric Magnetic Resonance Imaging and Reduce Unnecessary Multiparametric Magnetic Resonance Imaging Scan

Liu

Dong

et al. 2021

Front. Oncol.

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Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis

et al. 2020

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Reviewer #4: The authors are still failing to take the problem of heterogeneity seriously. The latest response was "well, yes, the results are all over the place, but most results are pretty good". First off, it is not at all clear to this reviewer that a negative predictive value of 85%, the threshold used by the authors, is acceptable. Would most patients be happy to be told that they only have a 15% risk of high-grade cancer, so not to worry about it? That is approximately the risk for a PSA of 10. How many urologists would argue against giving a biopsy to a man with a PSA of 10?Second, the point about heterogeneity is absolutely not to find out where the majority of results lie. For instance, if this was a meta-analysis of complication risk after abortion, and there was gross heterogeneity, with most clinics having very low rates and a few having very high rates, I'm pretty sure the conclusion wouldn't be only that "abortion is a safe procedure". More likely, there would be something about there being some unsafe clinics, and then an analysis to determine the characteristics of those clinics (e.g. solo practice) or a call for further research to determine why some clinics have poor outcomes. The current paper reads as if the authors came up with the conclusion first and then went through the motions of reporting forest plots and I2 statistics and so on. The conclusion that "Multiparametric MRI of the prostate is an accurate test for ruling-out clinically significant prostate cancer" is simply not an appropriate reflection of the data presented by the authors.Formatted: Font: Bold Commented [AL1]: I know we'd already done it but we don't need to point that out to AV. Hopefully he'll think we've now spotted the wisdom of his words and made the change requested. Don't want to give him any reason to dig his heals in.

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Can we rely on a negative multiparametric MRI to exclude significant prostate cancer at biopsy? Results from a regional cancer centre

Cited by 2 publications

References 0 publications

Developing Strategy to Predict the Results of Prostate Multiparametric Magnetic Resonance Imaging and Reduce Unnecessary Multiparametric Magnetic Resonance Imaging Scan

Developing Strategy to Predict the Results of Prostate Multiparametric Magnetic Resonance Imaging and Reduce Unnecessary Multiparametric Magnetic Resonance Imaging Scan

Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis

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