Detection limits of significant prostate cancer using multiparametric MR and digital rectal examination in men with low serum PSA: Up-date of the Italian Society of Integrated Diagnostic in Urology

Galosi, Andrea Benedetto; Palagonia, Erika; Scarcella, Simone; Cimadamore, Alessia; Lacetera, Vito; Fave, Rocco Francesco Delle; Antezza, Angelo; Dell’Atti, Lucio

doi:10.4081/aiua.2021.1.92

Cited by 11 publications

(9 citation statements)

References 63 publications

(52 reference statements)

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“…Studies have shown that the ORs and 95%CI of poor histological prognosis of prostate were 2.21 (1.30-3.76) and 1.58 (0.90-2.76) in men over 80 years old compared with those under 70 years old, respectively (20). Although this study did not prove a positive correlation between prostate volume and the occurrence of csPCa, several studies have confirmed that PSAD (PSA value/gland volume) was independently correlated to csPCa even in patients with serum PSA slightly above limits or even within normal limits, which was observed in every clinical scenario early diagnosis, repeat biopsy, and active surveillance (21). For example, Roscigno et al found that higher PSAD was associated with higher risk of reclassification at confirmatory or follow-up biopsy using 0.20 as cutoff (22).…”

Section: Clinical-radiomic Modelcontrasting

confidence: 66%

Utility of Clinical–Radiomic Model to Identify Clinically Significant Prostate Cancer in Biparametric MRI PI-RADS V2.1 Category 3 Lesions

et al. 2022

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PurposeTo determine the predictive performance of the integrated model based on clinical factors and radiomic features for the accurate identification of clinically significant prostate cancer (csPCa) among Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions.Materials and MethodsA retrospective study of 103 patients with PI-RADS 3 lesions who underwent pre-operative 3.0-T MRI was performed. Patients were randomly divided into the training set and the testing set at a ratio of 7:3. Radiomic features were extracted from axial T2WI, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) images of each patient. The minimum redundancy maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) feature selection methods were used to identify the radiomic features and construct a radiomic model for csPCa identification. Moreover, multivariable logistic regression analysis was used to integrate the clinical factors with radiomic feature model to further improve the accuracy of csPCa identification, and the two are presented in the form of normogram. The performance of the integrated model was compared with radiomic model and clinical model on testing set.ResultsA total of four radiomic features were selected and used for radiomic model construction producing a radiomic score (Radscore). Radscore was significantly different between the csPCa and the non-csPCa patients (training set: p < 0.001; testing set: p = 0.035). Multivariable logistic regression analysis showed that age and PSA could be used as independent predictors for csPCa identification. The clinical–radiomic model produced the receiver operating characteristic (ROC) curve (AUC) in the testing set was 0.88 (95%CI, 0.75–1.00), which was similar to clinical model (AUC = 0.85; 95%CI, 0.52–0.90) (p = 0.048) and higher than the radiomic model (AUC = 0.71; 95%CI, 0.68–1.00) (p < 0.001). The decision curve analysis implies that the clinical–radiomic model could be beneficial in identifying csPCa among PI-RADS 3 lesions.ConclusionThe clinical–radiomic model could effectively identify csPCa among biparametric PI-RADS 3 lesions and thus could help avoid unnecessary biopsy and improve the life quality of patients.

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Section: Clinical-radiomic Modelcontrasting

confidence: 66%

Utility of Clinical–Radiomic Model to Identify Clinically Significant Prostate Cancer in Biparametric MRI PI-RADS V2.1 Category 3 Lesions

et al. 2022

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“…This reallocation could lead to further investigations for the patient, with subsequently diagnostic pathway modifications and additional costs. Nevertheless, our hypothesis is validated by the recent changes of PI-RADS system, where DCE's role is to distinguish PI-RADS 3 versus PI-RADS 4 lesions, in case of T2 -DWI/ADC mismatch (25)(26)(27)(28)(29)(30)(31)(34)(35)(36)(37).…”

Section: Discussionmentioning

confidence: 61%

“…Diagnosis and management of Pca can be implemented by multivariate stratification based on patient risk (PSA, DRE, age), associated with BP-MRI (scenario 2). Some trials show that stratifying patients can be a winning strategy to maximize benefits and reduce costs for both diagnosis and therapy (14,(29)(30)(31)(32)(33)(34)(35)(36)(37). An important implication of BP-MRI, however, regards the PIRADS assessment categories, as already well explained in PIRADS guidelines v2.1 (2).…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of short biparametric magnetic resonance imaging protocol in men at risk of prostate cancer

Faccioli

Foti

Curti³

et al. 2022

Arch Ital Urol Androl

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Objectives: To compare the cost-effectiveness of a short biparametric MRI (BP-MRI) with that of contrast-enhanced multiparametric MRI (MP-MRI) for the detection of prostate cancer in men with elevated prostatespecific antigen (PSA) levels. Materials and methods: We compared two diagnostic procedures for detection of prostate cancer (Pca), BP-MRI and MP-MRI, in terms of quality-adjusted life years (QALY), incremental costeffectiveness ratio (ICER) and net monetary benefit (NMB) for a hypothetical cohort of 10,000 patients. We compared two scenarios in which different protocols would be used for the early diagnosis of prostate cancer in relation to PSA values. Scenario 1. BP-MRI/MP-MRI yearly if > 3.0 ng/ml, every 2 years otherwise; Scenario 2. BP-MRI/MP-MRI yearly with age-dependent threshold 3.5 ng/ml (50-59 years), 4.5 ng/ml (60-69 years), 6.5 ng/ml (70-79 years). Results: BP-MRI was more effective than the comparator in terms of cost (160.10 € vs 249.99€) QALYs (a mean of 9.12 vs 8.46), ICER (a mean of 232.45) and NMB (a mean of 273.439 vs 251.863). BP-MRI was dominant, being more effective and less expensive, with a lower social cost. Scenario 2 was more cost-effective compared to scenario 1. Conclusions: Our results confirmed the hypothesis that a short bi-parametric MRI protocol represents a cost-efficient procedure, optimizing resources in a policy perspective.

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“…Downsizing tumor can be related to MRI limitations. That could be also called “MRI undersizing”: tumor located at margins of the MR lesion are not visible at MRI ( 39 ). That is related to tumor heterogeneity in terms of not-round tumor shape and volume other than histologic sub-type and grading ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…That could be also called “MRI undersizing”: tumor located at margins of the MR lesion are not visible at MRI ( 39 ). That is related to tumor heterogeneity in terms of not-round tumor shape and volume other than histologic sub-type and grading ( 39 ). Combining these variables, we can imagine how many possible variations could influence final tumor extension and exact location of the most aggressive tumor.…”

Section: Discussionmentioning

confidence: 99%

TRUS-Guided Target Biopsy for a PI-RADS 3–5 Index Lesion to Reduce Gleason Score Underestimation: A Propensity Score Matching Analysis

et al. 2022

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BackgroundMagnetic resonance imaging (MRI) and transrectal ultrasound (TRUS)-guided cognitive or image fusion biopsy is performed to target a prostate imaging reporting and data system (PI-RADS) 3–5 lesion. Biopsy Gleason score (GS) is frequently underestimated compared to prostatectomy GS. However, it is still unclear about how many cores on target are necessary to reduce undergrading and if additional cores around the target may improve grade prediction on surgical specimen.PurposeTo determine the number of target cores and targeting strategy to reduce GS underestimation.Materials and MethodsBetween May 2017 and April 2020, a total of 385 patients undergoing target cognitive or image fusion biopsy of PI-RADS 3–5 index lesions and radical prostatectomies (RP) were 2:1 matched with propensity score using multiple variables and divided into the 1–4 core (n = 242) and 5–6 core (n = 143) groups, which were obtained with multiple logistic regression with restricted cubic spline curve. Target cores of 1–3 and 4–6 were sampled from central and peripheral areas, respectively. Pathologic outcomes and target cores were retrospectively assessed to analyze the GS difference or changes between biopsy and RP with Wilcoxon signed-rank test.ResultsThe median of target cores was 3 and 6 in the 1–4 core and 5–6 core groups, respectively (p < 0.001). Restricted cubic spline curve showed that GS upgrade was significantly reduced from the 5th core and there was no difference between 5th and 6th cores. Among the matched patients, 35.4% (136/385; 95% confidence interval, 0.305–0.403) had a GS upgrade after RP. The GS upgrades in the 1–4 core and 5–6 core groups were observed in 40.6% (98/242, 0.343–0.470) and 26.6% (38/143, 0.195–0.346), respectively (p = 0.023). Although there was no statistical difference between the matched groups in terms of RP GS (p = 0.092), the 5–6 core group had significantly higher biopsy GS (p = 0.006) and lower GS change from biopsy to RP (p = 0.027).ConclusionFive or more target cores sampling from both periphery and center of an index tumor contribute to reduce GS upgrade.

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Detection limits of significant prostate cancer using multiparametric MR and digital rectal examination in men with low serum PSA: Up-date of the Italian Society of Integrated Diagnostic in Urology

Cited by 11 publications

References 63 publications

Utility of Clinical–Radiomic Model to Identify Clinically Significant Prostate Cancer in Biparametric MRI PI-RADS V2.1 Category 3 Lesions

Utility of Clinical–Radiomic Model to Identify Clinically Significant Prostate Cancer in Biparametric MRI PI-RADS V2.1 Category 3 Lesions

Cost-effectiveness analysis of short biparametric magnetic resonance imaging protocol in men at risk of prostate cancer

TRUS-Guided Target Biopsy for a PI-RADS 3–5 Index Lesion to Reduce Gleason Score Underestimation: A Propensity Score Matching Analysis

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