Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for Advanced Risk Modeling of Prostate Cancer—Patient-tailored Risk Stratification Can Reduce Unnecessary Biopsies

Radtke, Jan Philipp; Wiesenfarth, Manuel; Kesch, Claudia; Freitag, Martin T.; Alt, Céline D.; Celik, Kamil; Distler, Florian; Roth, Wilfried; Wieczorek, Kathrin; Stock, Christian; Duensing, Stefan; Roethke, Matthias; Teber, Doğu; Schlemmer, Heinz Peter; Hohenfellner, Markus; Bonekamp, David; Hadaschik, Boris

doi:10.1016/j.eururo.2017.03.039

Cited by 161 publications

(188 citation statements)

References 27 publications

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“…All the novel nomograms had high AUCs: ModDis (0.83; 95% CI 0.78–0.87), MRI‐ERSPC‐RC3/4 (0.82; 95% CI 0.78–0.87) and ModRad (0.85; 95% CI 0.81–0.89). Comparing the AUCs of our cohort with the published cohorts of the novel models, we found nearly identical AUCs for MRI‐ERSPC‐RC3/4 (0.82 vs 0.84–0.85), ModDis (0.83 vs 0.79) and ModRad (0.85 vs 0.81–0.83) .…”

Section: Discussionsupporting

confidence: 53%

External validation of novel magnetic resonance imaging‐based models for prostate cancer prediction

Püllen¹,

Radtke

Wiesenfarth

et al. 2019

BJU International

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Objectives To validate, in an external cohort, three novel risk models, including the recently updated European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator, that combine multiparametric magnetic resonance imaging (mpMRI) and clinical variables to predict clinically significant prostate cancer (PCa). Patients and Methods We retrospectively analysed 307 men who underwent mpMRI prior to transperineal ultrasound fusion biopsy between October 2015 and July 2018 at two German centres. mpMRI was rated by Prostate Imaging Reporting and Data System (PI‐RADS) v2.0 and clinically significant PCa was defined as International Society of Urological Pathology Gleason grade group ≥2. The prediction performance of the three models (MRI‐ERSPC‐3/4, and two risk models published by Radtke et al. and Distler et al., ModRad and ModDis) were compared using receiver‐operating characteristic (ROC) curve analyses, with area under the ROC curve (AUC), calibration curve analyses and decision curves used to assess net benefit. Results The AUCs of the three novel models (MRI‐ERSPC‐3/4, ModRad and ModDis) were 0.82, 0.85 and 0.83, respectively. Calibration curve analyses showed the best intercept for MRI‐ERSPC‐3 and ‐4 of 0.35 and 0.76. Net benefit analyses indicated clear benefit of the MRI‐ERSPC‐3/4 risk models compared with the other two validated models. The MRI‐ERSPC‐3/4 risk models demonstrated a discrimination benefit for a risk threshold of up to 15% for clinically significant PCa as compared to the other risk models. Conclusion In our external validation of three novel prostate cancer risk models, which incorporate mpMRI findings, a head‐to‐head comparison indicated that the MRI‐ERSPC‐3/4 risk model in particular could help to reduce unnecessary biopsies.

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Section: Discussionsupporting

confidence: 53%

External validation of novel magnetic resonance imaging‐based models for prostate cancer prediction

Püllen¹,

Radtke

Wiesenfarth

et al. 2019

BJU International

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“…Diverse diagnostic and monitoring strategies have been investigated previously; these have involved adding clinical parameters or subcharacteristics of target lesions to mpMRI results. [17][18][19][20] We here confirmed the value of PSAD as a csPCa predictor in PI-RADS 3 patients. Washino et al showed that the PI-RADS version 2 score and PSAD were independent risk factors for PCa and csPCa.…”

Section: Discussionsupporting

confidence: 82%

Is it worth carrying out ultrasound–magnetic resonance imaging fusion targeted biopsy on Prostate Imaging Reporting and Data System score 3 prostate lesions?

Kim

Park

et al. 2020

Int J of Urology

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Abbreviations & Acronyms csPCa = clinically significant prostate cancer DCE = dynamic contrastenhanced DWI = diffusion-weighted imaging GS = Gleason score insignPCa = clinically insignificant prostate cancer mpMRI = multiparametric magnetic resonance imaging MRFB = ultrasoundmagnetic resonance imaging fusion targeted biopsy MRI = magnetic resonance imaging PCa = prostate cancer PI-RADS = Prostate Imaging Reporting and Data System PSA = prostate-specific antigen PSAD = prostate-specific antigen density ROC = receiver operating characteristic TRUSGB = transrectal ultrasound guided systemic biopsy

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“…Currently, there is conflicting evidence in studies comparing image‐fusion and cognitive targeting . For the sampling extent of biopsies, high probability MRI lesions were found to still require a combination of targeted MRI/US image‐fusion and systematic transperineal biopsies . Moreover, MRI may still miss Gleason score 7 cancer in 8–24% of patients on a lesion‐by‐lesion basis when prostatectomy serves as the reference standard .…”

Section: Introductionmentioning

confidence: 99%

Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy‐naïve men with suspicion of prostate cancer

et al. 2017

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MRI-based transperineal biopsy performed at high-volume tertiary care centres with a significant experience of prostate mpMRI and image-guided targeted biopsies yielded high detection rates of Gleason score 7-10 cancer. Prostate biopsies may not be needed for men with low PSAD and an unsuspicious MRI. In patients with high probability lesions, combined targeted and systematic biopsies are recommended.

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Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for Advanced Risk Modeling of Prostate Cancer—Patient-tailored Risk Stratification Can Reduce Unnecessary Biopsies

Cited by 161 publications

References 27 publications

External validation of novel magnetic resonance imaging‐based models for prostate cancer prediction

External validation of novel magnetic resonance imaging‐based models for prostate cancer prediction

Is it worth carrying out ultrasound–magnetic resonance imaging fusion targeted biopsy on Prostate Imaging Reporting and Data System score 3 prostate lesions?

Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy‐naïve men with suspicion of prostate cancer

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