MP05-14 THE DIAGNOSTIC PATHWAY OF PROSTATE CANCER IN THE MRI ERA INCLUDING RISK STRATIFICATION: APPLYING THE ROTTERDAM PROSTATE CANCER RISK CALCULATOR TO THE PRECISION TRIAL DATA

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP05)1 Sep 2021MP05-14 THE DIAGNOSTIC PATHWAY OF PROSTATE CANCER IN THE MRI ERA INCLUDING RISK STRATIFICATION: APPLYING THE ROTTERDAM PROSTATE CANCER RISK CALCULATOR TO THE PRECISION TRIAL DATA Sebastiaan Remmers, Veeru Kasivisvanathan, Caroline Moore, Monique Roobol, and Ivo de Vos Sebastiaan RemmersSebastiaan Remmers More articles by this author , Veeru KasivisvanathanVeeru Kasivisvanathan More articles by this author , Caroline MooreCaroline Moore More articles by this author , Monique RoobolMonique Roobol More articles by this author , and Ivo de VosIvo de Vos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001972.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The multiple externally validated Rotterdam Prostate Cancer Risk Calculator (RPCRC and RPCRC- MRI) can be used as upfront risk stratification in the diagnostic pathway of prostate cancer (PC) and has shown to reduce the number of systematic biopsies (SBx), MRIs, and/or targeted biopsies (TBx) with good discrimination. Calibration issues can be solved by an intercept adaption, although calibration alone to correct for differences between the a priori risk in a contemporary clinical cohort may not suffice and also thresholds for referral need to be investigated. We retrospectively assessed the effect of upfront use of the RPCRC (developed in screening cohort) and RPCRC-MRI (developed in clinical cohort) in men all biopsy naïve with elevated risk solely on the basis of an elevated PSA level and normal DRE in the PRECISION trial [ref1]. METHODS: We recalibrated the models and assessed the performance of the RPCRC and RPCRC-MRI by discrimination, calibration and clinical utility. Originally risk thresholds for biopsy were at least 20% for any PC and 4% for clinically significant (c)PC (defined as Grade Group ≥2). RESULTS: In the TRUS arm of the PRECISION trial (i.e, all men SBx), the performance of the RPCRC was good (Fig), but stressed the importance of recalibration. Net benefit (NB) was observed from a recalibrated probability of 29% any PC and 10% cPC compared to biopsy all men. Without recalibration, the median (IQR) probability of men with cPC was 9.2 (5.4-20.9), but after recalibration this was 29.2 (19.0-51.9). With the threshold of 20% any PC or 10% cPC, 27% of all SBx could be avoided missing 5 cases of cPC (2xGG2, 2xGG3, 1xGG4; range PSA 4.2-6.9, PSA density 0.06-0.09) in line with previously reported [ref2], OR = 2.1 (95% CI 0.42-11.6), p=.3. In the MRI arm, the RPCRC without recalibration could have avoided 35% of all MRIs which is similar as previously reported [ref 2]. Recalibration of the RPCRC-MRI was not a necessity. For the men with a positive MRI, the original RPCRC-MRI with a threshold of 20% or 4% csPCa could lead to an reduction of 8% of all TBx missing 1 GG2 tumor. CONCLUSIONS: In conclusion, assessing the a priori risk is crucial not only for calibration but also for potential adaptation of the proposed cut-off for referral. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e83-e84 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sebastiaan Remmers More articles by this author Veeru Kasivisvanathan More articles by this author Caroline Moore More articles by this author Monique Roobol More articles by this author Ivo de Vos More articles by this author Expand All Advertisement Loading ...