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

Autor: Falagario U; Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy. ugofalagario@gmail.com.; Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA. ugofalagario@gmail.com., Jambor I; Department of Radiology, University of Turku, Turku, Finland.; Department of Radiology, Icahn School of Medicine At Mount Sinai, New York, NY, USA.; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland., Taimen P; Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland., Syvänen KT; Department of Urology, University of Turku and Turku University Hospital, Turku, Finland., Kähkönen E; Department of Urology, University of Turku and Turku University Hospital, Turku, Finland., Merisaari H; Department of Radiology, University of Turku, Turku, Finland.; Department of Future Technologies, University of Turku, Turku, Finland., Montoya Perez I; Department of Radiology, University of Turku, Turku, Finland.; Department of Future Technologies, University of Turku, Turku, Finland., Knaapila J; Department of Urology, University of Turku and Turku University Hospital, Turku, Finland., Steiner A; Department of Radiology, University of Turku, Turku, Finland.; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland., Verho J; Department of Radiology, University of Turku, Turku, Finland.; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland., Tewari A; Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA., Aronen HJ; Department of Radiology, University of Turku, Turku, Finland.; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland., Carrieri G; Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy., Boström PJ; Department of Urology, University of Turku and Turku University Hospital, Turku, Finland., Ettala O; Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2021 Jun; Vol. 39 (6), pp. 1879-1887. Date of Electronic Publication: 2020 Aug 10.
DOI: 10.1007/s00345-020-03393-8
Abstrakt: Purpose: We aimed to develop and externally validate a nomogram based on MRI volumetric parameters and clinical information for deciding when SBx should be performed in addition to TBx in man with suspicious prostate MRI.
Materials and Methods: Retrospective analyses of single (IMPROD, NCT01864135) and multi-institution (MULTI-IMPROD, NCT02241122) clinical trials. All men underwent a unique rapid biparametric magnetic resonance imaging (IMPROD bpMRI) consisting of T2-weighted imaging and three separate DWI acquisitions. Men with IMPROD bpMRI Likert scores of 3-5 were included. Logistic regression models were developed using IMPROD trial (n = 122) and validated using MULTI-IMPROD trial (n = 262) data. The model's performance was evaluated in the terms of PCa detection with Gleason Grade Group 1 (clinically insignificant prostate cancer, iPCa) and > 1 (clinically significant prostate cancer, csPCa). Net benefits and decision curve analyses (DCA) were compared. Combined biopsies were used for reference.
Results: The developed nomogram included age, PSA, prostate volume, MRI suspicion score (IMPROD bpMRI Likert or PIRADsv2.1 score), MRI-suspicion lesion volume percentage, and lesion location. All these variables were significant predictors of csPCa in SBx in multivariable analysis. In the validation cohort (n = 262) using different nomogram cutoffs, 19-43% of men would have avoided SBx while missing 1-4% of csPCa and avoiding detection of 9-20% of iPCa. Similar performance was found for nomograms using IMPROD bpMRI Likert score or v2.1.
Conclusions: The developed nomogram demonstrated potential to select men with a clinical suspicion of PCa who would benefit from performing SBx in addition to TBx. Public access to the nomogram is provided at: https://petiv.utu.fi/multiimprod/ .
Databáze: MEDLINE
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