Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making

Abstract

PurposeThe purpose of this study is to explore the value of combining bpMRI and clinical indicators in the diagnosis of clinically significant prostate cancer (csPCa), and developing a prediction model and Nomogram to guide clinical decision-making.MethodsWe retrospectively analyzed 530 patients who underwent prostate biopsy due to elevated serum prostate specific antigen (PSA) levels and/or suspicious digital rectal examination (DRE). Enrolled patients were randomly assigned to the training group (n = 371, 70%) and validation group (n = 159, 30%). All patients underwent prostate bpMRI examination, and T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences were collected before biopsy and were scored, which were respectively named T2WI score and DWI score according to Prostate Imaging Reporting and Data System version 2 (PI-RADS v.2) scoring protocol, and then PI-RADS scoring was performed. We defined a new bpMRI-based parameter named Total score (Total score = T2WI score + DWI score). PI-RADS score and Total score were separately included in the multivariate analysis of the training group to determine independent predictors for csPCa and establish prediction models. Then, prediction models and clinical indicators were compared by analyzing the area under the curve (AUC) and decision curves. A Nomogram for predicting csPCa was established using data from the training group.ResultsIn the training group, 160 (43.1%) patients had prostate cancer (PCa), including 128 (34.5%) with csPCa. Multivariate regression analysis showed that the PI-RADS score, Total score, f/tPSA, and PSA density (PSAD) were independent predictors of csPCa. The prediction model that was defined by Total score, f/tPSA, and PSAD had the highest discriminatory power of csPCa (AUC = 0.931), and the diagnostic sensitivity and specificity were 85.1% and 87.5%, respectively. Decision curve analysis (DCA) showed that the prediction model achieved an optimal overall net benefit in both the training group and the validation group. In addition, the Nomogram predicted csPCa revealed good estimation when compared with clinical indicators.ConclusionThe prediction model and Nomogram based on bpMRI and clinical indicators exhibit a satisfactory predictive value and improved risk stratification for csPCa, which could be used for clinical biopsy decision-making.

Prebiopsy bpMRI and hematological parameter-based risk scoring model for predicting outcomes in biopsy-naive men with PSA 4–20 ng/mL

“…No statistically significant difference between the two methods was found. Pan et al 32 defined a new parameter based on bpMRI, which was calculated from the T2WI and DWI scores and showed greater PCa discriminating power (AUC = 0.900). Taking together, bpMRI and mpMRI showed nearly the same performance in PCa diagnosis.…”

Detection of intermediate- and high-risk prostate cancer with biparametric magnetic resonance imaging: a systematic review and meta-analysis

“…This left 87 studies that were potentially relevant. The full text of each of these studies was read, which identified 16 studies (6,174 patients) for inclusion in this meta-analysis (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). To guarantee that the populations included were nonoverlapping, we did not include articles published by the same authors and determined whether the patients of the included studies were from different hospitals.…”

“…The characteristics of the included studies are presented in Tables 1-3. Of the 16 studies, 13 were retrospective (17)(18)(19)(20)(21)(22)(23)(24)(26)(27)(28)30,31) and 3 were prospective (16,25,29). Nine studies included consecutive patients.…”

“…1.5-T MRI (DWI b=1,400 mm 2 /s (26,27). Only 2 studies mentioned the use of intrarectal coils during examinations (19,27), and 7 articles did not report specific coil types (21,(24)(25)(26)28,30,31).…”

“…1.5-T MRI (DWI b=1,400 mm 2 /s (26,27). Only 2 studies mentioned the use of intrarectal coils during examinations (19,27), and 7 articles did not report specific coil types (21,(24)(25)(26)28,30,31). Readers' experience in the studies ranged from 3 to 25 years, with 6 studies not specifying the radiologists' experience (19,23,24,26,28,30).…”