Challenges in Adopting Level 1 Evidence for Multiparametric Magnetic Resonance Imaging as a Biomarker for Prostate Cancer Screening

Kim, Soo Jeong; Hu, Jim C.

doi:10.1001/jamaoncol.2018.4160

Cited by 28 publications

(25 citation statements)

References 8 publications

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“…Despite strong evidence demonstrating better outcomes of a new technological innovation, real-world evidence must be gathered to assess its effectiveness beyond the population in which it was developed and validated. As use of prostate MRI has grown in recent years, estimates show its adoption as a reflex test for elevated PSA would contribute billions of healthcare dollars annually 28. Our finding of low performance of PI-RADS 3 for Asian-Americans in an experienced center has significant implications for prostate cancer screening and biopsy overuse in men of Asian descent.…”

Section: Discussionmentioning

confidence: 83%

Race and prostate imaging: implications for targeted biopsy and image-based prostate cancer interventions

Groß

Shoag

Banerjee

et al. 2019

BMJ Surg Interv Health Technologies

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PurposeFor men with an elevated prostate-specific antigen (PSA), there is a strong evidence for prostate MRI to assess the risk of clinically significant prostate cancer (CSPC) and guide targeted-biopsy interventions. Prostate MRI is assessed using the Prostate Imaging-Reporting and Data System (PI-RADS), which is scored from 1 to 5. Equivocal or suspicious findings (PI-RADS 3–5) are recommended for subsequent targeted biopsy, for which the risk of infection and sepsis is increasing. However, PI-RADS was developed primarily in men of European descent. We sought to elucidate PI-RADS and MRI-targeted biopsy outcomes in Asian men, a rapidly growing population in the USA, Europe, Australia and internationally.Materials and methodsA prospective cohort of 544 men with elevated PSA without a diagnosis of prostate cancer who underwent MRI-targeted biopsy at our institution from January 2012 to December 2018 was analyzed. We categorized the cohort by self-designated race then used a validated algorithm which uses surname lists to identify a total of 78 (14%) Asian-Americans. The primary outcome was the likelihood of diagnosing CSPC (Gleason grade group >1) in Asian-Americans versus non-Asian-Americans. Multivariable logistic regression was used to determine the association of demographic and other characteristics with CSPC.ResultsOverall, MRI-targeted biopsy identified CSPC in 17% of Asian-American men versus 39% of non-Asian-American men (p<0.001). Notably for PI-RADS 3, only 6% of Asian-Americans versus 15% of others were diagnosed with CSPC. In adjusted analyses, Asian-American men were less likely to be diagnosed on MRI-targeted biopsy with CSPC (OR 0.30, 95% CI 0.14 to 0.65, p=0.002) and indolent prostate cancer (OR 0.37, 95% CI 0.15 to 0.91, p=0.030) than other races. Regardless of race those who were biopsy naïve were more likely (OR 2.25, 95% CI 1.45 to 3.49, p<0.001) to be diagnosed with CSPC.ConclusionWe found that PI-RADS underperforms in Asian-American men. For instance, only 2 of 35 (6%) Asian-American men with PI-RADS 3 were diagnosed with CSPC on MRI targeted biopsy. This has significant implications for overuse of diagnostic and image-guided interventional approaches in Asian-Americans, given the increasing risk of infectious complications from biopsy. Additional validation studies are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 83%

Race and prostate imaging: implications for targeted biopsy and image-based prostate cancer interventions

Groß

Shoag

Banerjee

et al. 2019

BMJ Surg Interv Health Technologies

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“…Additionally, >20% of men who did not undergo mpMRI did not do so because of a lack of insurance approval. This may reflect socio‐economic differences between the groups and also relates to the high costs of mpMRI that make routine implementation difficult . Lastly, the presented findings mostly apply to positive mpMRI scans; the number of underdiagnosed men with negative scans may only be speculated upon, given the lack of follow‐up data in this population.…”

mentioning

confidence: 93%

Multiparametric magnetic resonance imaging for prostate cancer detection: do clinical trial findings reflect real‐world practice?

2019

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“…Magnetic resonance imaging (MRI) with prostate-specific antigen (PSA) density (PSAd) is increasingly being utilized to detect clinically significant prostate cancer (sPCa) and to avoid unnecessary invasive procedures/operations. The use of biparametric prostate MRI (bpMRI) instead of multiparametric MRI to decrease time and cost is an admirable effort, since resource and cost constraints have been major limitations to the widespread incorporation of MRI into diagnostic protocols [1]. Using prospective clinical trial data, this study shows that the use of a high IMPROD bpMRI Likert lesion or a lower IMPROD bpMRI lesion threshold with a high PSAd threshold can yield respectable negative and positive predictive values, while avoiding 35% of biopsies and missing 6% of sPCa [2].…”

mentioning

confidence: 99%

Re: Juha Knaapila, Ivan Jambor, Ileana Montoya Perez, et al. Prebiopsy IMPROD Biparametric Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Diagnosis of Prostate Cancer: An External Validation Study. Eur Urol Oncol 2020;3:648–656

Jue

Alameddine

2020

European Urology Oncology

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Challenges in Adopting Level 1 Evidence for Multiparametric Magnetic Resonance Imaging as a Biomarker for Prostate Cancer Screening

Cited by 28 publications

References 8 publications

Race and prostate imaging: implications for targeted biopsy and image-based prostate cancer interventions

Race and prostate imaging: implications for targeted biopsy and image-based prostate cancer interventions

Multiparametric magnetic resonance imaging for prostate cancer detection: do clinical trial findings reflect real‐world practice?

Re: Juha Knaapila, Ivan Jambor, Ileana Montoya Perez, et al. Prebiopsy IMPROD Biparametric Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Diagnosis of Prostate Cancer: An External Validation Study. Eur Urol Oncol 2020;3:648–656

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