Defining a Cohort that May Not Require Repeat Prostate Biopsy Based on PCA3 Score and Magnetic Resonance Imaging: The Dual Negative Effect

Perlis, Nathan; Alkasab, Thamir; Ahmad, Ardalan E.; Goldberg, Estee; Fadak, Kamel; Sayid, Rashid; Finelli, Antonio; Kulkarni, Girish S.; Hamilton, R.; Zlotta, Alexandre R.; Ghai, Sangeet; Fleshner, Neil

doi:10.1016/j.juro.2017.11.074

Cited by 23 publications

(24 citation statements)

References 16 publications

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“…Others have attempted to use prostate biomarkers in combination with mpMRI to enhance the accuracy for predicting GR [7,15,25,26]. For example, Lai et al [7] found that the combination of mpMRI and PSAD when added to other clinical parameters yielded an AUC of 0.84, which was significantly greater than either mpMRI alone (AUC 0.74) or PSAD alone (AUC 0.77).…”

Section: Discussionmentioning

confidence: 99%

Prostate Health Index and multiparametric magnetic resonance imaging to predict prostate cancer grade reclassification in active surveillance

et al. 2020

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Objective To identify the value of combining the Prostate Health Index (PHI) and multiparametric magnetic resonance imaging (mpMRI), tools which have previously been shown to be independently predictive of prostate cancer (PCa) grade reclassification (GR; Gleason score >6), for the purpose of predicting GR at the next surveillance biopsy to reduce unnecessary prostate biopsies for men in PCa active surveillance (AS). Patients and Methods Between 2014 and 2019, we retrospectively identified 253 consecutive men in the Johns Hopkins AS programme who had mpMRI and PHI followed by a systematic ± targeted biopsy. PHI and PHI density (PHID) were evaluated across Prostate Imaging‐Reporting and Data System version 2.0 (PI‐RADSv2) scores and compared to those with and without GR. Next, the negative predictive value (NPV) and area under the receiver operating curve (AUC) were calculated to compare the diagnostic value of PI‐RADSv2 score combined with PHI, PHID, or prostate‐specific antigen density (PSAD) for GR using their respective first quartile as a cut‐off. Results Of the 253 men, 38 men (15%) had GR. Men with GR had higher PHI values (40.7 vs 32.0, P = 0.001), PHID (0.83 vs 0.57, P = 0.007), and PSAD (0.12 vs 0.10, P = 0.037). A PI‐RADSv2 ≤3 alone had a NPV of 91.6% for GR (AUC 0.67). Using a PHI cut‐off of 25.6 in addition to PI‐RADSv2 ≤3, the NPV and AUC were both increased to 98% and 0.70, respectively. Using a PSAD cut‐off of 0.07 ng/mL/mL with PI‐RADSv2 had an AUC of 0.69 and NPV of 95.4%. PHI and PI‐RADSv2 together could have avoided 20% of biopsies at the cost of missing 2.6% of GRs. Conclusions The combination of PHI and mpMRI can aid in the prediction of GR in men on AS and may be useful for decreasing the burden of surveillance prostate biopsies.

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Section: Discussionmentioning

confidence: 99%

Prostate Health Index and multiparametric magnetic resonance imaging to predict prostate cancer grade reclassification in active surveillance

et al. 2020

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“…However, patient selection methods based on risk calculators cannot localize csPCa within the gland, which may be missed by systematic biopsy. Diagnostic yields of biopsy procedures can be increased by using imaging to refine patient selections [20][21][22][23], and thereafter to direct biopsies to suspicious locations, thus reducing the number of men undergoing biopsy and consequently overtreatments of men with insignificant disease [24]. Central to these developments are the emerging roles of multiparametric magnetic resonance imaging (mpMRI) and MR-directed biopsy (MRDB; refers to all biopsy methods using prior mpMRI information) for PCa diagnosis and treatment selection.…”

Section: Addressing Clinical Needs In Pca Diagnosismentioning

confidence: 99%

Prostate Imaging-Reporting and Data System Steering Committee: PI-RADS v2 Status Update and Future Directions

et al. 2019

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Multiparametric magnetic resonance imaging (MRI) and MRI-directed biopsies using the Prostate Imaging-Reporting and Data System improves the detection of prostate cancers likely to cause harm, and at the same time decreases the detection of disease that does not lead to harms if left untreated. The keys to success are high-quality imaging, reporting, and biopsies by radiologists and urologists working together in multidisciplinary teams.

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“…Perlis and colleagues presented results based on 128 nonsuspicious mpMRIs. No patient with a non-suspicious mpMRI and a normal PCA3 score had significant cancer on biopsy (NPV=100% (p <0.0001)) [37]. Gnanapragasam and colleagues reported the results of a PHI test combined with a non-suspicious mpMRI in 94 patients.…”

Section: Biomarkers and Risk Calculatorsmentioning

confidence: 99%

What to expect from a non-suspicious prostate MRI? A review

Fiard

Norris

Nguyen

et al. 2020

Progrès en Urologie

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Abbreviations mpMRI Multiparametric Magnetic Resonance Imaging NPV Negative Predictive Value Résumé Contexte : La réalisation d'une IRM multiparamétrique (IRMmp) est désormais recommandée avant la réalisation de biopsies prostatiques. En revanche, la conduite à tenir en présence d'une IRMmp non-suspecte (Score Likert ou PIRADS 1-2) est toujours débattue. Objectifs : Faire une synthèse de la littérature récente pour répondre à trois questions. 1) Faut-il réaliser des biopsies systématisées en présence d'une IRMmp non suspecte ? 2) Quels facteurs prédictifs permettent de définir les patients candidats à une biopsie systématisée ? 3) Le manque de visibilité de certains cancers peut-elle être expliquée et quelles en sont les conséquences cliniques ? Sources : Une revue narrative de la littérature a été réalisée à partir des bases de données Medline utilisant deux recherches avec les termes "MRI" AND "prostate cancer" AND ("diagnosis" OR "biopsy") AND ("non-suspicious" OR "negative" OR "invisible") ; "prostate cancer MRI visible". Les références des articles sélectionnés ont été analysées à la recherche d'articles supplémentaires. Sélection des études : Les études publiées dans les 5 dernières années en anglais ont été analysées et retenues si les données disponibles permettaient de répondre à l'une des 3 questions posées. Résultats : Considérant les cancers de grade ISUP ³ 2 cliniquement significatifs, la valeur prédictive négative (VPN) de l'IRMmp était comprise entre 76% et 99%, dépendante de la prévalence du cancer et du type de test de référence utilisé. La VPN était plus élevée chez les patients aux antécédents de biopsie négative (88-96%), et plus faible chez les patients en surveillance active (85-90%). La densité de PSA (PSAd) avec un seuil de PSAd<0.15ng/ml/ml était le facteur prédictif le plus étudié et le plus pertinent associé à l'IRMmp pour éliminer un cancer significatif. Enfin, les tumeurs non visibles à l'IRMmp présentaient des différences au niveau histopathologique et génétique, conférant un intérêt clinique à la visibilité IRM. Limites du travail : La plupart des données proviennent de centres experts et les résultats peuvent ne pas être reproductibles en dehors. Conclusion : L'IRMmp fait preuve de performances diagnostiques élevées pour éliminer un cancer cliniquement significatif. La densité de PSA peut être utilisée pour sélectionner patients devant avoir une biopsie. Une meilleure connaissance des mécanismes à l'origine de la visibilité du cancer devrait aider le développement de nomogrammes et biomarqueurs plus précis.

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Defining a Cohort that May Not Require Repeat Prostate Biopsy Based on PCA3 Score and Magnetic Resonance Imaging: The Dual Negative Effect

Cited by 23 publications

References 16 publications

Prostate Health Index and multiparametric magnetic resonance imaging to predict prostate cancer grade reclassification in active surveillance

Prostate Health Index and multiparametric magnetic resonance imaging to predict prostate cancer grade reclassification in active surveillance

Prostate Imaging-Reporting and Data System Steering Committee: PI-RADS v2 Status Update and Future Directions

What to expect from a non-suspicious prostate MRI? A review

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