A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI

Abstract

Purpose: To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx). Materials and Methods:We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination.Discrimination was evaluated with area under the receiver operating characteristic (AUROC).Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC.Results: Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75. Conclusions:Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI

MRI and biopsy in prostate cancer are the hot topic in this number of International Brazilian Journal of Urology

“…Dr. Kaneko and collegues from USA and Japan performed in page 319 ( 6 ) the paper that is the cover of the present edition. This Interesting paper is about a nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI and concluded that this nomogram facilitates evaluating individual probability of clinically significant prostate cancer (CSPCa) on prostatic biopsy (PBx) in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided.…”