A 4K score/MRI‐based nomogram for predicting prostate cancer, clinically significant prostate cancer, and unfavorable prostate cancer

Abstract

Background: The detection of prostate cancer requires histological confirmation in biopsy core. Currently, number of unnecessary prostate biopsies are being performed in the United States. This is due to the absence of appropriate biopsy decision-making protocol.Aim: To develop and validate a 4K score/multiparametric magnetic resonance imaging (mpMRI)-based nomogram to predict prostate cancer (PCa), clinically significant prostate cancer (csPCa), and unfavorable prostate cancer (uPCa).Methods and Results: Retrospective, single-center study evaluating a cohort of 574 men with 4K score test >7% or suspicious digital rectal examination (DRE) or Prostate Imaging Reporting and Data System (PI-RADS) scores 3, 4, or 5 on mpMRI that underwent systematic and/or mpMRI/ultrasound fusion-targeted prostate biopsy between 2016 and 2020. External cohort included 622 men. csPCa and uPCa were defined as Gleason score ≥3 + 4 and ≥4 + 3 on biopsy, respectively. Multivariable logistic regression analysis was performed to build nomogram for predicting PCa, csPCa, and uPCa. Validation was performed by plotting the area under the curve (AUC) and comparing nomogram-predicted probabilities with actual rates of PCa, csPCa, and uPCa probabilities in the external cohort.4K score, a PI-RADS ≥4, prostate volume and prior negative biopsy were significant predictors of PCa, csPCa, and uPCa. AUCs were 0.84, 0.88, and 0.86 for the prediction of PCa, csPCa, and uPCa, respectively. The predicted and actual rates of PCa, csPCa, and uPCa showed agreement across all percentage probability ranges in the validation cohort. Using the prediction model at threshold of 30, 30% of overall biopsies, 41% of benign biopsies, and 19% of diagnosed indolent PCa could be avoided, while missing 9% of csPCa. Conclusion:This novel nomogram would reduce unnecessary prostate biopsies and decrease detection of clinically insignificant PCa.

The Efficacy of Proclarix to Select Appropriate Candidates for Magnetic Resonance Imaging and Derived Prostate Biopsies in Men with Suspected Prostate Cancer

“…The comparison between Proclarix and other markers is difficult [ 24 25 26 27 28 ]. SelectMDx seems more sensitive than mpMRI but less specific [ 24 ].…”

“…4K test has been shared with mpMRI and clinical variables in a predictive nomogram [ 26 ]. In a study of 266 biopsy-naïve men in whom 74 csPCa were detected (27.8%), 4K <7.5 will avoid 32 (12%) mpMRI and 1 csPCa between 74 (1.4%) csPCa will be misdiagnosed [ 27 ]. Prostate Health Index has been analyzed only in biopsied men with PI-RADS ≥3 [ 28 ].…”

Clinical Utility of Negative Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer and Clinically Significant Prostate Cancer

“…Multiparametric magnetic resonance imaging (mpMRI) has emerged as a promising tool for guiding prostate biopsy decision-making. The introduction of mpMRI-targeted prostate biopsy has increased the detection of clinically significant disease and reduced the number of unnecessary biopsies and the detection of clinically indolent cancers [1] , [2] , [3] , [4] . The most recent European Association of Urology guidelines [5] recommend against biopsy for men with an abnormal prostate-specific antigen (PSA) and negative mpMRI findings, provided the suspected risk of aggressive cancer is low and the patient has discussed the pros and cons of forgoing biopsy with a doctor.…”

Integration of magnetic resonance imaging into prostate cancer nomograms

“…The AUC for these three were 0.84, 0.88, and 0.86 compared to 0.73, 0.80, and 0.81 for 4 K score alone. 36 …”