Risk-based MRI-directed diagnostic pathway outperforms non-risk-based pathways in suspected prostate cancer biopsy-naïve men: a large cohort validation study

Bittencourt, Leonardo Kayat; Guricová, Karolína; Zucker, Isaac; Durieux, Jared; Schoots, Ivo G.

doi:10.1007/s00330-021-08407-6

Cited by 12 publications

(11 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 72 studies including 36 366 patients with suspected csPCa who underwent prostate MRI and subsequent biopsy were included (Figure 1). Details of the included study and patient characteristics are summarized in Table 1 and eTables 3 to 5 in Supplement 1. Studies were published between 2016 and 2022.…”

Section: Resultsmentioning

confidence: 99%

“…None of the included studies enrolled patients with prior csPCa. Among the 72 included studies, 19 solely included patients with low to moderate risk of csPCa (ie, PI-RADS≤3 and/or transitional zone index lesion and/or total PSA <10 ng/mL), 1 study solely included high-risk patients with PI-RADS 4 or greater, and the remaining 52 studies included all suspected patients regardless of the prostate MRI results or clinical parameters . The most frequently used imaging was 3.0 T (92.6%) and multiparametric MRI (80.3%).…”

Section: Resultsmentioning

confidence: 99%

“…As such, ancillary clinical data have been proposed to complement MRI to minimize the number of unnecessary biopsies. This concept has been recently expanded by numerous studies, and several MRI-based risk models and strategies have been developed to guide decisions on prostate biopsy . However, it has been challenging to integrate the proposed approaches into clinical practice owing to considerable inconsistencies among them.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Haj-Mirzaian,

Burk,

Lacson

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceMultiple strategies integrating magnetic resonance imaging (MRI) and clinical data have been proposed to determine the need for a prostate biopsy in men with suspected clinically significant prostate cancer (csPCa) (Gleason score ≥3 + 4). However, inconsistencies across different strategies create challenges for drawing a definitive conclusion.ObjectiveTo determine the optimal prostate biopsy decision-making strategy for avoiding unnecessary biopsies and minimizing the risk of missing csPCa by combining MRI Prostate Imaging Reporting &amp; Data System (PI-RADS) and clinical data.Data SourcesPubMed, Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to July 1, 2022.Study SelectionEnglish-language studies that evaluated men with suspected but not confirmed csPCa who underwent MRI PI-RADS followed by prostate biopsy were included. Each study had proposed a biopsy plan by combining PI-RADS and clinical data.Data Extraction and SynthesisStudies were independently assessed for eligibility for inclusion. Quality of studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and the Newcastle-Ottawa Scale. Mixed-effects meta-analyses and meta-regression models with multimodel inference were performed. Reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.Main Outcomes and MeasuresIndependent risk factors of csPCa were determined by performing meta-regression between the rate of csPCa and PI-RADS and clinical parameters. Yields of different biopsy strategies were assessed by performing diagnostic meta-analysis.ResultsThe analyses included 72 studies comprising 36 366 patients. Univariable meta-regression showed that PI-RADS 4 (β-coefficient [SE], 7.82 [3.85]; P = .045) and PI-RADS 5 (β-coefficient [SE], 23.18 [4.46]; P &lt; .001) lesions, but not PI-RADS 3 lesions (β-coefficient [SE], −4.08 [3.06]; P = .19), were significantly associated with a higher risk of csPCa. When considered jointly in a multivariable model, prostate-specific antigen density (PSAD) was the only clinical variable significantly associated with csPCa (β-coefficient [SE], 15.50 [5.14]; P &lt; .001) besides PI-RADS 5 (β-coefficient [SE], 9.19 [3.33]; P &lt; .001). Avoiding biopsy in patients with lesions with PI-RADS category of 3 or less and PSAD less than 0.10 (vs &lt;0.15) ng/mL2 resulted in reducing 30% (vs 48%) of unnecessary biopsies (compared with performing biopsy in all suspected patients), with an estimated sensitivity of 97% (vs 95%) and number needed to harm of 17 (vs 15).Conclusions and RelevanceThese findings suggest that in patients with suspected csPCa, patient-tailored prostate biopsy decisions based on PI-RADS and PSAD could prevent unnecessary procedures while maintaining high sensitivity.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Haj-Mirzaian,

Burk,

Lacson

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…1). Firstly, it is possible to adjust patient selections by incorporating PSA-density values with positive and negative MRI scan results [9], with or without additional clinical factors that informing on the risk of having an important cancer [10,11]. Secondly, by thresholding on a different PI-RADS assessment category biopsy decisions (e.g.…”

mentioning

confidence: 99%

“…Bittencourt et al [11] retrospectively evaluated the impact of different diagnostic pathways, in a cohort of biopsy-naïve men at high risk for prostate cancer, who came to their reference centre for MRI-ultrasound fusion prostate biopsy. They compared systematic biopsies in all patients, with different Fig.…”

mentioning

confidence: 99%

Balancing the benefits and harms of MRI-directed biopsy pathways

2022

View full text Add to dashboard Cite

Before a prostate biopsy, the likely benefits and the harms emanating from true and false test MRI results need to be balanced. Prioritizing patients' preferences and their tolerance to potential harms are essential to assess.• The decision curve analysis method is an analytical framework where the net clinical benefit is plotted against a range of risk thresholds of having important cancers, helping patients and their physicians to decide between cancer averse (important cancers being detected) and biopsy averse (biopsies avoided) strategies. • The decision curve analysis method showed that the incorporation of clinical risk factors with MRI findings optimizes biopsy outcomes over a range of clinically relevant risk thresholds, compared to other biopsy strategies.

show abstract