Qualitative and Quantitative Reporting of a Unique Biparametric MRI: Towards Biparametric MRI‐Based Nomograms for Prediction of Prostate Biopsy Outcome in Men With a Clinical Suspicion of Prostate Cancer (IMPROD and MULTI‐IMPROD Trials)

Abstract

Background: Multiparametric MRI of the prostate has been shown to improve the risk stratification of men with an elevated prostate-specific antigen (PSA). However, long acquisition time, high cost, and inter-center/reader variability of a routine prostate multiparametric MRI limit its wider adoption. Purpose: To develop and validate nomograms based on unique rapid biparametric MRI (bpMRI) qualitative and quantitative derived variables for prediction of clinically significant cancer (SPCa). Study Type: Retrospective analyses of single (IMPROD, NCT01864135) and multiinstitution trials (MULTI-IMPROD, NCT02241122). Population: 161 and 338 prospectively enrolled men who completed the IMPROD and MULTI-IMPROD trials, respectively. Field Strength/Sequence: IMPROD bpMRI: 3T/1.5T, T 2 -weighted imaging, three separate diffusion-weighted imaging (DWI) acquisitions: 1) b-values 0, 100, 200, 300, 500 s/mm 2 ; 2) b values 0, 1500 s/mm 2 ; 3) values 0, 2000 s/mm 2 . Assessment: The primary endpoint of the combined trial analysis was the diagnostic accuracy of the combination of IMPROD bpMRI and clinical variables for detection of SPCa.View this article online at wileyonlinelibrary.com.

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)

“…Additionally, in patients with positive MRI, two to four extra target cores were taken from each suspicious lesion. The data sets were restricted to men with a PSA value of <20 ng/ml and no prior diagnosis of PCa; thus, the included final population may differ from that in prior publications, which included some men from these cohorts [2,4,17].…”

“…Such an approach binds the decision to perform biopsy to the clinical suspicion of PCa to be determined using MRI, risk calculators, and biomarkers [1]. While several risk calculators and biomarkers have been developed and are currently under evaluation [2][3][4], the "MRI pathway" is supported by level 1 evidence, but seems to be limited by the low to moderate inter-reader and -center reproducibility and the low specificity/positive predictive value (PPV) [5][6][7]. 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].…”

Does Multiparametric Magnetic Resonance of Prostate Outperform Risk Calculators in Predicting Prostate Cancer in Biopsy Naïve Patients?

“…Having said this, additional external validation studies in different biopsy settings are warranted since the clinical utility of these models could be cohort dependent. It is also worth mentioning that calculators including mpMRI, though outperforming the mpMRI naïve ones, involve obtaining mpMRI in all patients and this may not be afforded in centers with limited resources ( 28 ). Conversely, mpMRI naïve RCs offer the unique opportunity to potentially tailor further testing, such as mpMRI and PBx itself, on an individual basis.…”

Added value of systematic biopsy in men with a clinical suspicion of prostate cancer undergoing biparametric MRI-targeted biopsy: multi-institutional external validation study

“…In the recent years, Magnetic Resonance Imaging (MRI) is increasingly used in the diagnostic pathways for prostate cancer (PCa). Simplified MRI protocols with shorter acquisition time and with no use of contrast agents (biparametric MRI) hold the promise to further reduce costs of prostate imaging and promote its use in any patient at risk of PCa [1,2]. Furthermore, compared to other tools such as biomarkers, prostate MRI allows to characterize and localize PCa lesions and to eventually perform targeted biopsy of any suspicious lesions.…”