Multiparametric magnetic resonance imaging outperforms the Prostate Cancer Prevention Trial risk calculator in predicting clinically significant prostate cancer

Abstract

BACKGROUND:The Prostate Cancer Prevention Trial risk calculator for high-grade (PCPTHG) prostate cancer (CaP) was developed to improve the detection of clinically significant CaP. In this study, the authors compared the performance of the PCPTHG against multiparametric magnetic resonance imaging (MP-MRI) in predicting men at risk of CaP. METHODS: Men with an abnormal prostatespecific antigen (PSA) level or digital rectal examination (DRE) and a suspicious lesion on a 3-Tesla MP-MRI were enrolled prospectively. Three radiologists reviewed and graded all lesions on a 5-point Likert scale. Biopsy of suspicious lesion(s) was performed using a proprietary MRI/transrectal ultrasound fusion-guided prostate biopsy system, after which 12-core biopsy was performed. A genitourinary pathologist reviewed all pathology slides. The performance of PCPTHG was compared with that of MP-MRI in predicting clinically significant CaP. RESULTS: Of 175 men who were eligible for analysis, 64.6% (113 of 175 men) were diagnosed with CaP, including 93 of 113 men (82.3%) who had clinically significant disease. Age, abnormal DRE, PSA, PSA density, prostate size, extraprostatic extension on MRI, apparent diffusion coefficient value, and MRI lesion size were identified as significant predictors of high-grade CaP (all P <.05). The area under the receiver operating characteristic curve of PCPTHG for predicting high-grade CaP was 0.676 (95% confidence interval [CI], 0.592-0.751). By using a risk cutoff of 15% for biopsy as, proposed previously for high-grade CaP, sensitivity was 96.4%, specificity was 7.6%, and the false-positive rate was 51.1%. In contrast, the area under the receiver operating characteristic curve of MP-MRI for high-grade CaP was 0.769 (95% CI, 0.703-0.834), and it was 0.812 (95% CI, 0.754-0.

Role of Multi-Parametric Magnetic Resonance Image and PIRADS Score in Patients with Prostate Cancer Eligible for Active Surveillance According PRIAS Criteria

“…Regardless of our results, literature also shows mp-MRI as a reasonable noninvasive method for upgrading detection. Salami et al [30] obtained an AUC 10 percentage points better than the Prostate Cancer Prevention Trial risk calculator for high-grade in predicting high-grade PCa (0.769 vs. 0.676) for lesion suspicion level on mp-MRI. In our study, the short number of patients and the strict selection criteria had probably influenced on the negative correlation between PIRADS and upgrading.…”

Detection of Prostate Cancer Metastasis by Whole Body Magnetic Resonance Imaging Combined with Bone Scintigraphy and PSA Levels

“…2A), suggesting its vital clinical role in early manifestation of PCa exacerbation [35][36][37][38][39]. Virtually, PCa was confirmed by MRI when low-signal nodules were present within peripheral zone that was intense in T2W1.…”

Optimizing Patient Population for MP-MRI and Fusion Biopsy for Prostate Cancer Detection

“…A recent study compared the PCPT calculator to mp-MRI in detecting clinically significant prostate cancer in men with either elevated PSA or abnormal digital rectal examination (DRE) and suspicious lesions seen on MRI, defining significant cancer as Gleason ≥7. They observed an area under curve (AUC) of 0.769 (95 % CI, 0.703-0.834) for lesion suspicion level on mp-MRI in predicting high-grade prostate cancer, which was 10 percentage points better than the PCPT AUC of 0.676 (95 % CI, 0.592-0.751; p=0.091 [22]). …”