Improving the Early Detection of Clinically Significant Prostate Cancer in Men in the Challenging Prostate Imaging-Reporting and Data System 3 Category

Moróte, Juan; Campistol, Míriam; Triquell, Marina; Celma, A.; Regis, Lucas; Torres, Inés de; Semidey, María Eugenia; Mast, Richard; Santamaría, Anna; Planas, Jacques; Trilla, E.

doi:10.1016/j.euros.2021.12.009

Cited by 12 publications

(19 citation statements)

References 31 publications

(46 reference statements)

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“…This is the first head-to-head study between PSAD, the externally validated MRI-ERSPC predictive model, and the new marker Proclarix for the proper selection of candidates for prostate biopsy after mpMRI. Morote et al [ 26 ] analyzed the behavior of Proclarix in the same series of patients but in the subgroup of men with PI-RADS 3 category. The results obtained demonstrated that Proclarix outperformed PSAD in the detection of csPCa in this specific scenario (PI-RADS 3 category), considered the most uncertain of PI-RADS.…”

Section: Discussionmentioning

confidence: 99%

“…Proclarix increased the negative predictive value of mpMRI from 94% to 100%, while a prostate biopsy was required in 70% of men with negative mpMRI [ 4 , 5 ]. In contrast, PSAD recommended prostate biopsy in 69% of men with negative mpMRI, leaving 50% of csPCa undetected [ 10 , 26 ]. Finally, MRI-ERSPC RC recommended biopsy in 37% of men with negative mpMRI but missed 83.3% of csPCa.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Proclarix, PSA Density and MRI-ERSPC Risk Calculator to Select Patients for Prostate Biopsy after mpMRI

Campistol

Morote

Triquell

et al. 2022

Cancers

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Tools to properly select candidates for prostate biopsy after magnetic resonance imaging (MRI) have usually been analyzed in overall populations with suspected prostate cancer (PCa). However, the performance of these tools can change regarding the Prostate Imaging-Reporting and Data System (PI-RADS) categories due to the different incidence of clinically significant PCa (csPCa). The objective of the study was to analyze PSA density (PSAD), MRI-ERSPC risk calculator (RC), and Proclarix to properly select candidates for prostate biopsy regarding PI-RADS categories. We performed a head-to-head analysis of 567 men with suspected PCa, PSA > 3 ng/mL and/or abnormal rectal examination, in whom two to four core transrectal ultrasound (TRUS) guided biopsies to PI-RADS ≥ three lesions and/or 12-core TRUS systematic biopsies were performed after 3-tesla mpMRI between January 2018 and March 2020 in one academic institution. The overall detection of csPCa was 40.9% (6% in PI-RADS < 3, 14.8% in PI-RADS 3, 55.3% in PI-RADS 4, and 88.9% in PI-RADS 5). MRI-ERSPC model exhibited a net benefit over PSAD and Proclarix in the overall population. Proclarix outperformed PSAD and MRI-ERSPC RC in PI-RADS ≤ 3. PSAD outperformed MRI-ESRPC RC and Proclarix in PI-RADS > 3, although none of them exhibited 100% sensitivity for csPCa in this setting. Therefore, tools to properly select candidates for prostate biopsy after MRI must be analyzed regarding the PI-RADS categories. While MRI-ERSPC RC outperformed PSAD and Proclarix in the overall population, Proclarix outperformed in PI-RADS ≤ 3, and no tool guaranteed 100% detection of csPCa in PI-RADS 4 and 5.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Proclarix, PSA Density and MRI-ERSPC Risk Calculator to Select Patients for Prostate Biopsy after mpMRI

Campistol

Morote

Triquell

et al. 2022

Cancers

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“…The researchers concluded that the machine learning classifiers performed better than PSAD in the detection of csPCa among PI-RADS 3 lesions. In 2022, Morote et al [13] prospectively compared three methods (Proclarix blood test, ERSPC-MRI model, PSAD) to delineate the csPCa among patients with PI-RADS 3 lesions. The researchers found that Proclarix was the most accurate method since it detected all csPCa cases and it could reduce prostate biopsies by 21.3%.…”

Section: Discussionmentioning

confidence: 99%

The Value of Prostate-Specific Antigen Density in Combination with Lesion Diameter for the Accuracy of Prostate Cancer Prediction in Prostate Imaging-Reporting and Data System 3 Prostate Lesions

Senel,

Koudonas,

Uzun

et al. 2023

Urol Int

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Introduction: The aim of the study was to investigate the value of prostate-specific antigen density (PSAD) and lesion diameter (LD) combination in prostate cancer (PCa) detection. Methods: 181 patients who were detected to have prostate imaging-reporting and data system (PI-RADS) 3 lesions in mpMRI and underwent prostate biopsies were included in the study. Demographic, clinical, and pathological data of all patients were evaluated. The patients were divided into four groups according to PSAD and LD status (PSAD <0.15 ng/mL/cc + LD <1 cm, PSAD <0.15 ng/mL/cc + LD ≥1 cm, PSAD ≥0.15 ng/mL/cc + LD <1 cm, and PSAD ≥0.15 ng/mL/cc + LD ≥1 cm). Diagnostic ability for PCa and clinical significant PCa (csPCa) was evaluated by PSAD and LD. Results: PSAD ≥0.15 ng/mL/cc (OR = 6; 95% Cl = 2.847–12.647; p < 0.001), LD ≥1 cm (OR = 7.341; 95% confidence interval [CI] = 2.91–18.52; p < 0.001), and combination of PSAD ≥0.15 ng/mL/cc and LD ≥1 cm (OR = 10.023; 95% CI = 4.32–23.252; p < 0.001) were associated with PCa detection rates. The most sensitivity, specificity, negative, and positive predictive values were found in PSAD ≥0.15 ng/mL/cc + LD ≥1 cm group for both PCa and csPCa detection (48.8%, 92%, 85.2%, and 65.6% for any PCa detection; 66.7%, 85.2%, 97.3%, and 24.2% for csPCa detection, respectively). Conclusion: The presence of PSAD ≥0.15 ng/mL/cc or LD ≥1 cm in mpMRI of patients with PI-RADS 3 lesions is associated significantly with the finding of PCa and particularly with the detection of csPCa.

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“…Granata et al, always in the setting of gastrointestinal neoplasms, analyzed 88 patients and tried to outline peculiar MRI features which could allow the differentiation between intrahepatic cholangiocarcinoma and other forming-mass benign mimickers [ 3 ]. El-Shater Bosaily, Turkbey, Scialpi and Morote exploited the potential role of MRI diagnostic assessment in prostatic disease: they showed that the PI-RADS v2 scoring system could limit the detection of equivocal lesions, thus leading to the avoidance of unnecessary biopsies and to the accurate selection of patients who really deserve such an invasive diagnostic approach [ 5 , 6 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the improvements in terms of implementation of this imaging method in clinical practice, it is well known that some issues still exist, like the management of Prostate Imaging Reporting and Data System (PI-RADS) score 3 lesions or the inter-reader variability among clinicians with different levels of expertise [ 7 ]. Moreover, various essays have been tested to improve the accuracy of mpMRI in this setting [ 8 ]. Indeed, many clinicians feel that the PI-RADS v2 scoring system can be inadequate in distinguishing clinically significant and insignificant groups in central gland tumours [ 9 ].…”

Section: Diagnostic Imaging and Its Predictive Value Before Treatment...mentioning

confidence: 99%

Integration between Novel Imaging Technologies and Modern Radiotherapy Techniques: How the Eye Drove the Chisel

Morelli

Carnevale

Grassi

et al. 2022

Cancers

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Introduction: Targeted dose-escalation and reduction of dose to adjacent organs at risk have been the main goal of radiotherapy in the last decade. Prostate cancer benefited the most from this process. In recent years, the development of Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiotherapy (SBRT) radically changed clinical practice, also thanks to the availability of modern imaging techniques. The aim of this paper is to explore the relationship between diagnostic imaging and prostate cancer radiotherapy techniques. Materials and Methods: Aiming to provide an overview of the integration between modern imaging and radiotherapy techniques, we performed a non-systematic search of papers exploring the predictive value of imaging before treatment, the role of radiomics in predicting treatment outcomes, implementation of novel imaging in RT planning and influence of imaging integration on use of RT in current clinical practice. Three independent authors (GF, IM and ID) performed an independent review focusing on these issues. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used, and grey literature was searched for further papers of interest. The final choice of papers included was discussed between all co-authors. Results: This paper contains a narrative report and a critical discussion of the role of new modern techniques in predicting outcomes before treatment, in radiotherapy planning and in the integration with systemic therapy in the management of prostate cancer. Also, the role of radiomics in a tailored treatment approach is explored. Conclusions: Integration between diagnostic imaging and radiotherapy is of great importance for the modern treatment of prostate cancer. Future clinical trials should be aimed at exploring the real clinical benefit of complex workflows in clinical practice.

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Improving the Early Detection of Clinically Significant Prostate Cancer in Men in the Challenging Prostate Imaging-Reporting and Data System 3 Category

Cited by 12 publications

References 31 publications

Comparison of Proclarix, PSA Density and MRI-ERSPC Risk Calculator to Select Patients for Prostate Biopsy after mpMRI

Comparison of Proclarix, PSA Density and MRI-ERSPC Risk Calculator to Select Patients for Prostate Biopsy after mpMRI

The Value of Prostate-Specific Antigen Density in Combination with Lesion Diameter for the Accuracy of Prostate Cancer Prediction in Prostate Imaging-Reporting and Data System 3 Prostate Lesions

Integration between Novel Imaging Technologies and Modern Radiotherapy Techniques: How the Eye Drove the Chisel

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