Real-world use of MRI for risk stratification prior to prostate biopsy

Siddiqui, Mohammad Rashid; Ansbro, Brandon; Shah, Palak; Aguiar, Jonathan A.; Li, Eric V.; Rich, Jordan; Mahenthiran, Ashorne; Moataz, Soliman A. S.; Keeter, Mary-Kate; Mai, Quan; Mi, Xinlei; Schaeffer, Edward M.; Ross, Ashley E.

doi:10.1038/s41391-022-00543-4

Cited by 18 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The MRIs were graded using the Prostate Imaging–Reporting and Data System (PI-RADS), version 2.0 (scores range from 1 to 5, with higher scores indicating greater suspicion for PCa) . In the PHI cohort, PHI was used in more than 80% of patients during the decision to pursue MRI and/or biopsy, and biopsy was avoided in more than 30% of men who underwent MRI . Men who did not receive MRI and/or biopsy or who had a prior diagnosis of PCa were excluded for the present study.…”

Section: Methodsmentioning

confidence: 99%

“…14 In the PHI cohort, PHI was used in more than 80% of patients during the decision to pursue MRI and/or biopsy, and biopsy was avoided in more than 30% of men who underwent MRI. 9 Men who did not receive MRI and/or biopsy or who had a prior diagnosis of PCa were excluded for the present study. Complete case analysis was performed.…”

Section: Study Cohortsmentioning

confidence: 99%

“…Additional details specific to each cohort have been published previously. 3,9,10 All cohorts were external to the models selected below.…”

Section: Study Cohortsmentioning

confidence: 99%

“…Specifically, the use of novel advanced biomarkers to augment prostate-specific antigen (PSA) screening may change the risk pool of patients selected to undergo MRI and/or biopsy, with patients at lower risk potentially forgoing one or both. [9][10][11][12][13] Therefore, we compared diagnostic discrimination and calibration directly for the most promising MRI-based PCa risk calculators in the literature within independent external cohorts from Europe and North America. In addition, we compared the performance of the same models within a separate cohort with high utilization of an advanced serum biomarker, Prostate Health Index (PHI), as a reflex test in the PSA screening pathway.…”

Section: Introductionmentioning

confidence: 99%

“…The exact prevalence among men evaluated for clinical suspicion of harboring PCa may not be known, or it may change over time with modifications to screening practices within a particular institution, city, or country. Specifically, the use of novel advanced biomarkers to augment prostate-specific antigen (PSA) screening may change the risk pool of patients selected to undergo MRI and/or biopsy, with patients at lower risk potentially forgoing one or both …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Comparison of Magnetic Resonance Imaging–Based Risk Calculators to Predict Prostate Cancer Risk

Patel,

Remmers,

Ellis

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceMagnetic resonance imaging (MRI)–based risk calculators can replace or augment traditional prostate cancer (PCa) risk prediction tools. However, few data are available comparing performance of different MRI-based risk calculators in external cohorts across different countries or screening paradigms.ObjectiveTo externally validate and compare MRI-based PCa risk calculators (Prospective Loyola University Multiparametric MRI [PLUM], UCLA [University of California, Los Angeles]-Cornell, Van Leeuwen, and Rotterdam Prostate Cancer Risk Calculator–MRI [RPCRC-MRI]) in cohorts from Europe and North America.Design, Setting, and ParticipantsThis multi-institutional, external validation diagnostic study of 3 unique cohorts was performed from January 1, 2015, to December 31, 2022. Two cohorts from Europe and North America used MRI before biopsy, while a third cohort used an advanced serum biomarker, the Prostate Health Index (PHI), before MRI or biopsy. Participants included adult men without a PCa diagnosis receiving MRI before prostate biopsy.InterventionsProstate MRI followed by prostate biopsy.Main Outcomes and MeasuresThe primary outcome was diagnosis of clinically significant PCa (grade group ≥2). Receiver operating characteristics for area under the curve (AUC) estimates, calibration plots, and decision curve analysis were evaluated.ResultsA total of 2181 patients across the 3 cohorts were included, with a median age of 65 (IQR, 58-70) years and a median prostate-specific antigen level of 5.92 (IQR, 4.32-8.94) ng/mL. All models had good diagnostic discrimination in the European cohort, with AUCs of 0.90 for the PLUM (95% CI, 0.86-0.93), UCLA-Cornell (95% CI, 0.86-0.93), Van Leeuwen (95% CI, 0.87-0.93), and RPCRC-MRI (95% CI, 0.86-0.93) models. All models had good discrimination in the North American cohort, with an AUC of 0.85 (95% CI, 0.80-0.89) for PLUM and AUCs of 0.83 for the UCLA-Cornell (95% CI, 0.80-0.88), Van Leeuwen (95% CI, 0.79-0.88), and RPCRC-MRI (95% CI, 0.78-0.87) models, with somewhat better calibration for the RPCRC-MRI and PLUM models. In the PHI cohort, all models were prone to underestimate clinically significant PCa risk, with best calibration and discrimination for the UCLA-Cornell (AUC, 0.83 [95% CI, 0.81-0.85]) model, followed by the PLUM model (AUC, 0.82 [95% CI, 0.80-0.84]). The Van Leeuwen model was poorly calibrated in all 3 cohorts. On decision curve analysis, all models provided similar net benefit in the European cohort, with higher benefit for the PLUM and RPCRC-MRI models at a threshold greater than 22% in the North American cohort. The UCLA-Cornell model demonstrated highest net benefit in the PHI cohort.Conclusions and RelevanceIn this external validation study of patients receiving MRI and prostate biopsy, the results support the use of the PLUM or RPCRC-MRI models in MRI-based screening pathways regardless of European or North American setting. However, tools specific to screening pathways incorporating advanced biomarkers as reflex tests are needed due to underprediction.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Study Cohortsmentioning

confidence: 99%

“…Additional details specific to each cohort have been published previously. 3,9,10 All cohorts were external to the models selected below.…”

Section: Study Cohortsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of Magnetic Resonance Imaging–Based Risk Calculators to Predict Prostate Cancer Risk

Patel,

Remmers,

Ellis

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

show abstract

Utility of dynamic contrast enhancement for clinically significant prostate cancer detection

Li,

Kumar,

Aguiar

et al. 2024

BJUI Compass

View full text Add to dashboard Cite

ObjectiveThis study aimed to evaluate the association of dynamic contrast enhancement (DCE) with clinically significant prostate cancer (csPCa, Gleason Grade Group ≥2) and compare biparametric magnetic resonance imaging (bpMRI) and multiparametric MRI (mpMRI) nomograms.Subjects/patients and methodsWe identified a retrospective cohort of biopsy naïve patients who underwent pre‐biopsy MRI separated by individual MRI series from 2018 to 2022. csPCa detection rates were calculated for patients with peripheral zone (PZ) lesions scored 3–5 on diffusion weighted imaging (DWI) with available DCE (annotated as − or +). bpMRI Prostate Imaging Reporting and Data System (PIRADS) (3 = 3−, 3+; 4 = 4−, 4+; 5 = 5−, 5+) and mpMRI PIRADS (3 = 3−; 4 = 3+, 4−, 4+; 5 = 5−, 5+) approaches were compared in multivariable logistic regression models. Nomograms for detection of csPCa and ≥GG3 PCa incorporating all biopsy naïve patients who underwent prostate MRI were generated based on available serum biomarkers [PHI, % free prostate‐specific antigen (PSA), or total PSA] and validated with an independent cohort.ResultsPatients (n = 1010) with highest PIRADS lesion in PZ were included in initial analysis with 127 (12.6%) classified as PIRADS 3+ (PIRADS 3 on bpMRI but PIRADS 4 on mpMRI). On multivariable analysis, PIRADS 3+ lesions were associated with higher csPCa rates compared to PIRADS 3− (3+ vs. 3−: OR 1.86, p = 0.024), but lower csPCa rates compared to PIRADS DWI 4 lesions (4 vs. 3+: OR 2.39, p < 0.001). csPCa rates were 19% (3−), 31% (3+), 41.5% (4−), 65.9% (4+), 62.5% (5−), and 92.3% (5+). bpMRI nomograms were non‐inferior to mpMRI nomograms in the development (n = 1410) and independent validation (n = 353) cohorts. Risk calculators available at: https://rossnm1.shinyapps.io/MynMRIskCalculator/.ConclusionWhile DCE positivity by itself was associated with csPCa among patients with highest PIRADS lesions in the PZ, nomogram comparisons suggest that there is no significant difference in performance of bpMRI and mpMRI. bpMRI may be considered as an alternative to mpMRI for prostate cancer evaluation in many situations.

show abstract

Utilization trend of prebiopsy multiparametric magnetic resonance imaging and its impact on prostate cancer detection: Real‐world insights from a high‐volume center in southwest China

Zhang,

Tu,

Dai

et al. 2024

The Prostate

View full text Add to dashboard Cite

BackgroundData on the utilization and effects of prebiopsy prostate multiparametric magnetic resonance imaging (mpMRI) to support its routine use in real‐world setting are still scarce.ObjectiveTo evaluate the change of clinical practice of prebiopsy mpMRI over time, and assess its diagnostic accuracy.Design, Setting, and ParticipantsWe retrospectively analyzed data from 6168 patients who underwent primary prostate biopsy (PBx) between January 2011 and December 2021 and had prostate‐specific antigen (PSA) values ranging from 3 to 100 ng/mL.InterventionPrebiopsy MRI at the time of PBx.Outcome Measurements and Statistical AnalysisWe performed general linear regression and to elucidate trends in the annual use of prebiopsy mpMRI and conducted multivariable logistic regression to evaluate the potential benefits of incorporating prebiopsy mpMRI for prostate cancer (PCa) detection.Results and LimitationsThe utilization of prebiopsy mpMRI significantly increased from 9.2% in 2011 to 75.0% in 2021 (p < 0.001). In addition, prebiopsy mpMRI significantly reduced negative PBx by 8.6% while improving the detection of clinically significant PCa (csPCa) by 7.0%. Regression analysis showed that the utilization of prebiopsy mpMRI was significantly associated with a 48% (95% confidence interval [CI]: 1.19–1.84) and 36% (95% CI: 1.12–1.66) increased PCa detection rate in the PSA 3–10 ng/mL and 10–20 ng/mL groups, respectively; and a 34% increased csPCa detection rate in the PSA 10–20 ng/mL group (95% CI: 1.09–1.64). The retrospective design and the single center cohort constituted the limitations of this study.ConclusionsOur study demonstrated a notable rise in the utilization of prebiopsy mpMRI in the past decade. The adoption of this imaging technique was significantly associated with an increased probability of detecting prostate cancer.Patient SummaryFrom 2011 to 2021, we demonstrated a steady increase in the utilization of prebiopsy mpMRI among biopsy‐naïve men. We also confirmed the positive impact of prebiopsy mpMRI utilization on the detection of prostate cancer.

show abstract

Real-world use of MRI for risk stratification prior to prostate biopsy

Cited by 18 publications

References 18 publications

Comparison of Magnetic Resonance Imaging–Based Risk Calculators to Predict Prostate Cancer Risk

Comparison of Magnetic Resonance Imaging–Based Risk Calculators to Predict Prostate Cancer Risk

Utility of dynamic contrast enhancement for clinically significant prostate cancer detection

Utilization trend of prebiopsy multiparametric magnetic resonance imaging and its impact on prostate cancer detection: Real‐world insights from a high‐volume center in southwest China

Contact Info

Product

Resources

About