Prebiopsy IMPROD Biparametric Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Diagnosis of Prostate Cancer: An External Validation Study

Reply to Joshua S. Jue and Mahmoud Alameddine’s Letter to the Editor re: Juha Knaapila, Ivan Jambor, Ileana Montoya Perez, et al. Prebiopsy IMPROD Biparametric Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Diagnosis of Prostate Cancer: An External Validation Study. Eur Urol Oncol 2020;3:648–656

“…Using a higher PSA cutoff would probably have increased the PSAd and bpMRI performance. The median PSA values were similar but there were differences in prostate volumes, resulting in a lower mean PSAd in the study by Boesen et al [7] than in our cohort [6].…”

“…Our study [6] is based on retrospective analyses of registered prospective clinical trials (IMPROD and MULTI-IMPROD) for which the inclusion criteria were PSA 2.5 ng/ ml and/or abnormal findings on digital rectal examination [3,4]. The retrospective analyses by Boesen et al [2,7] included men enrolled with the inclusion criteria of PSA 4 ng/ml and/or an abnormal finding on digital rectal examination.…”

“…The retrospective analyses by Boesen et al [2,7] included men enrolled with the inclusion criteria of PSA 4 ng/ml and/or an abnormal finding on digital rectal examination. Our analyses were designed to validate the finding of Boesen et al, so multivariate analysis with additional clinical parameters was not included [6,7]. Differences in the study cohorts should be noted since the predictive values will vary depending on the prevalence, even if the sensitivity and specificity remain the same.…”

Combined Use of Prostate-specific Antigen Density and Magnetic Resonance Imaging for Prostate Biopsy Decision Planning: A Retrospective Multi-institutional Study Using the Prostate Magnetic Resonance Imaging Outcome Database (PROMOD)

“…Studies have shown that omitting biopsies in patients with no lesion on MRI would miss up to 5-11% of all csPCa cases (ISUP grade >2) [5,8], whereas performing biopsy in all patients with an equivocal MRI finding (PI-RADS 3 lesions considered to be positive by guidelines [9]) can result in a diagnosis of csPCa in 3-50% of the patients [5,8,10,11]. In this scenario, prostate-specific antigen (PSA) density (PSAd) is one of the strongest predictors of csPCa in risk models, and several studies found that PSAd and prostate MRI suspicion score, such as the PI-RADS score or Likert score, were significant independent predictors of csPCa at biopsy [12][13][14]. Specifically, in a single-center retrospective study, Boesen et al [14] investigated the use of biparametric prostate MRI (bpMRI), with no use of intravenous contrast agent, combined with PSAd with the aim of finding an optimal biopsy strategy in biopsy-naive patients.…”

Re: Juha Knaapila, Ivan Jambor, Ileana Montoya Perez, et al. Prebiopsy IMPROD Biparametric Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Diagnosis of Prostate Cancer: An External Validation Study. Eur Urol Oncol 2020;3:648–656

“…The use of biparametric prostate MRI (bpMRI) instead of multiparametric MRI to decrease time and cost is an admirable effort, since resource and cost constraints have been major limitations to the widespread incorporation of MRI into diagnostic protocols [1]. Using prospective clinical trial data, this study shows that the use of a high IMPROD bpMRI Likert lesion or a lower IMPROD bpMRI lesion threshold with a high PSAd threshold can yield respectable negative and positive predictive values, while avoiding 35% of biopsies and missing 6% of sPCa [2]. The study performed a decision curve analysis and multivariate logistic regression analysis with receiver operating characteristic (ROC) curve analysis and area under the ROC curve to compare the sPCa prediction ability of bpMRI and PSAd.…”