MP12-14 MODELS INTEGRATING MRI PREDICT PROSTATE CANCER UPGRADING ON CONFIRMATORY BIOPSY IN ACTIVE SURVEILLANCE PATIENTS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I1 Apr 2018MP12-14 MODELS INTEGRATING MRI PREDICT PROSTATE CANCER UPGRADING ON CONFIRMATORY BIOPSY IN ACTIVE SURVEILLANCE PATIENTS Nimrod S. Barashi, Shay Golan, Chi Wang, Kimberly Hirschhorn, Jacqueline Petkewicz, Robert Silvers, Kiran Thakrar, Scott E. Eggener, and Brian T. Helfand Nimrod S. BarashiNimrod S. Barashi More articles by this author , Shay GolanShay Golan More articles by this author , Chi WangChi Wang More articles by this author , Kimberly HirschhornKimberly Hirschhorn More articles by this author , Jacqueline PetkewiczJacqueline Petkewicz More articles by this author , Robert SilversRobert Silvers More articles by this author , Kiran ThakrarKiran Thakrar More articles by this author , Scott E. EggenerScott E. Eggener More articles by this author , and Brian T. HelfandBrian T. Helfand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with prostate cancer (PCa) being considered for active surveillance (AS) usually undergo a confirmatory biopsy (CBx). However, biopsies cause discomfort, generate extra cost, and carry a risk of infection. We created a series of models to predict upgrading on CBx. METHODS A prospective IRB approved database of men on AS from 2008-2016 was reviewed. We included men with ISUP (International Society of Urological Pathology) grade 1 on diagnostic biopsy (DBx), who underwent CBx within 12 months. We assessed baseline clinical data, DBx results, multiparametric prostate MRI (mpMRI), and PSA density (PSAD) results. Positive mpMRI was defined as presence of a PIRADS ≥3 lesion. A positive lesion resulted in an additional core ascertainment during MRI fusion-guided biopsies. PSAD was assessed as a continuous variable, and then dichotomized (cutoff =0.18 ng/ml2). Upgrading was diagnosed if the CBx showed an ISUP grade ≥2. We performed univariate logistic regression with all variables potentially associated with upgrading. A ″base model″ including age, race, and number of positive cores on DBx was created. Predictive models were built by adding variables to the base model (excluding those collinear). Accuracy was assessed using area under the ROC curve (AUC). RESULTS Among 279 men on AS, 134 (48‰) had mpMRI and 271 (97‰) PSAD prior to CBx. Of these, 59 (21‰) had a PSAD ≥ 0.18 ng/ml2, and 59 (21‰) had positive mpMRI. Upgrading was diagnosed on 41 men (14.7‰), six of which had ISUP ≥4 (2.2‰). On univariate analysis, positive mpMRI had the strongest association with upgrading (OR 8.03, 95‰ CI 2.9 - 27.3, p<0.001), followed by PSAD ≥ 0.18 ng/ml2 (OR 5.4, 95‰ CI 2.6 - 11.2, p<0.001). On multivariate analysis, the base model yielded an AUC=0.74. A model combining negative mpMRI, < 4 positive cores on DBx, and PSAD <0.18ng/ml2, yielded an AUC of 0.86 and NPV of 96‰. Furthermore, if we were to apply this model to our own cohort, we could have spared 44 patients (15.8‰) from undergoing CBx while missing one patient with ISUP=2. CONCLUSIONS mpMRI and PSAD can be used to better select patients for confirmatory biopsy prior to starting AS for PCa. Our models may represent accessible and potentially cost-effective tools for routine urologic practice, but external validation is needed. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e141 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nimrod S. Barashi More articles by this author Shay Golan More articles by this author Chi Wang More articles by this author Kimberly Hirschhorn More articles by this author Jacqueline Petkewicz More articles by this author Robert Silvers More articles by this author Kiran Thakrar More articles by this author Scott E. Eggener More articles by this author Brian T. Helfand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...