Multiparametric magnetic resonance imaging and clinical variables: Which is the best combination to predict reclassification in active surveillance patients?

Candiano

et al. 2021

Arch Ital Urol Androl

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Introduction: The detection rate for clinically significant prostate cancer (csPCa) in men with mpMRI PI-RADS score 3 diagnosed by affiliated radiology centers vs radiological reference center was evaluated. Materials and methods: From January 2017 to December 2020, 950 men (median age 64 years) underwent mpMRI for abnormal PSA values (median 6.3 ng/ml). Among the 950 patients who underwent mpMRI 500 were evaluated by a reference center and 450 by outpatient radiological affiliated centers. All the mpMRI index lesions characterized by a PI-RADS 3 underwent targeted cores combined with extended prostate biopsy. Two radiologists of the radiological reference center revised all the mpMRI lesions 3. Results: Overall, 361/950 (38%) patients had a mpMRI lesion PI-RADS score 3: 120/500 cases (24%) vs 241/450 cases (53.5%) were diagnosed by reference vs affiliated radiological centers. The detection rate for cT1c csPCa was equal to 26.7% (35/120 cases) vs 16.6% (40/241 cases) in men with PI-RADS 3 lesions diagnosed in the reference vs the affiliated radiological centers (p < 0.05). Among the 241 PI-RADS score 3 lesions diagnosed by affiliated radiological centers 86/241 (35.7%) and 36/241 (15%) were downgraded (PI-RADS scores < 3) and upgraded (PI-RADS score 4) by the dedicated radiologists of the reference center. Conclusions: In our series, about 35% and 15% of PI-RADS score 3 lesions diagnosed by affiliated radiological centers were downgraded and upgraded when revised by experencied radiologists, therefore a second opinion is mandatory especially in men enrolled in active surveillance protocols in whom mpMRI is recommended to reduce the number of scheduled repeated prostate biopsies.

Section: Discussionmentioning

confidence: 99%

mpMRI PI-RADS score 3 lesions diagnosed by reference vs affiliated radiological centers: Our experience in 950 cases

Candiano

et al. 2021

Arch Ital Urol Androl

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“…In this respect, although mpMRI is strongly recommended in the revaluation of men in AS [ 2 , 5 ], scheduled systematic repeated prostate biopsies are still recommended in addition to targeted mpMRI/TRUS fusion biopsy to reduce the false negative rate for csPCa of mpMRI equal to 20% of the cases [ 17 ]. At the same time, the number of cores performed at initial repeat evaluation is directly correlated with a lower risk of reclassification [ 6 ] during the follow-up, allowing to postpone scheduled repeated prostate biopsy in favour of clinical findings (i.e., PSA density, risk calculator) [ 18 ] and imaging revaluation (mpMRI) [ 5 , 16 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Could 68Ga-PSMA PET/CT Evaluation Reduce the Number of Scheduled Prostate Biopsies in Men Enrolled in Active Surveillance Protocols?

Roscigno

et al. 2022

JCM

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Background: To evaluate the accuracy of 68Ga-prostate specific membrane antigen (PSMA) PET/CT in the diagnosis of clinically significant prostate cancer (csPCa) (Grade Group > 2) in men enrolled in Active Surveillance (AS) protocol. Methods: From May 2013 to May 2021, 173 men with very low-risk PCa were enrolled in an AS protocol study. During the follow-up, 38/173 (22%) men were upgraded and 8/173 (4.6%) decided to leave the AS protocol. After four years from confirmatory biopsy (range: 48–52 months), 30/127 (23.6%) consecutive patients were submitted to mpMRI and 68Ga-PSMA PET/CT scan before scheduled repeated biopsy. All the mpMRI (PI-RADS > 3) and 68Ga-PET/TC standardised uptake value (SUVmax) > 5 g/mL index lesions underwent targeted cores (mpMRI-TPBx and PSMA-TPBx) combined with transperineal saturation prostate biopsy (SPBx: median 20 cores). Results: mpMRI and 68Ga-PSMA PET/CT showed 14/30 (46.6%) and 6/30 (20%) lesions suspicious for PCa. In 2/30 (6.6%) men, a csPCa was found; 68Ga-PSMA-TPBx vs. mpMRI-TPBx vs. SPBx diagnosed 1/2 (50%) vs. 1/2 (50%) vs. 2/2 (100%) csPCa, respectively. In detail, mpMRI and 68Ga-PSMA PET/TC demonstrated 13/30 (43.3%) vs. 5/30 (16.7%) false positive and 1 (50%) vs. 1 (50%) false negative results. Conclusion: 68Ga-PSMA PET/CT did not improve the detection for csPCa of SPBx but would have spared 24/30 (80%) scheduled biopsies showing a lower false positive rate in comparison with mpMRI (20% vs. 43.3%) and a negative predictive value of 85.7% vs. 57.1%, respectively.

“…Our study demonstrated that the combination of PSAD and PI-RADS was benefitted for detection of any PCa in PZ. In several recent studies, Roscigno et al demonstrated that that mpMRI is not accurate enough during the AS follow-up, and it is still necessary to combine mpMRI with other clinical variables to improve the predictive accuracy (25,26). As a standardized reporting system, the PI-RADS has been validated and widely applied in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

PI-RADS v2.1 Combined With Prostate-Specific Antigen Density for Detection of Prostate Cancer in Peripheral Zone

Wen

Tang

et al. 2022

Front. Oncol.

PurposeTo evaluate the diagnostic performance of combining the Prostate Imaging Reporting and Data System (PI-RADS) scoring system v2.1 with prostate-specific antigen density (PSAD) to detect prostate cancer (PCa).MethodsA total of 266 participants with suspicion of PCa underwent multiparametric magnetic resonance imaging (mpMRI) in our hospital, after at least 4 weeks all patients underwent subsequent systematic transrectal ultrasound (TRUS)-guided biopsy or MRI-TRUS fusion targeted biopsy. All mpMRI images were scored in accordance with the PI-RADS v2.1, and univariate and multivariate logistic regression analyses were performed to determine significant predictors of PCa.ResultsA total of 119 patients were diagnosed with PCa in the biopsy, of them 101 patients were diagnosed with clinically significant PCa. The multivariate analysis revealed that PI-RADS v2.1 and PSAD were independent predictors for PCa. For peripheral zone (PZ), the area under the ROC curve (AUC) for the combination of PI-RADS score and PSAD was 0.90 (95% CI 0.83-0.96), which is significantly superior to using PI-RADS score (0.85, 95% CI 0.78-0.93, P=0.031) and PSAD alone (0.83, 95% CI 0.75-0.90, P=0.037). For transition zone (TZ), however, the combination model was not significantly superior to PI-RADS alone, with AUC of 0.94 (95% CI 0.89-0.99) vs. 0.93 (95% CI 0.88-0.97, P=0.186).ConclusionThe combination of PI-RADS v2.1 with PSAD could significantly improve the diagnostic performance of PCa in PZ. Nevertheless, no significant improvement was observed regarding PCa in TZ.