MP26-11 CLINICAL UTILITY OF 4KSCORE WHEN COMBINED WITH PSA, TRUS AND MPMRI FOR THE DETECTION OF HIGH-GRADE PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-11 CLINICAL UTILITY OF 4KSCORE WHEN COMBINED WITH PSA, TRUS AND MPMRI FOR THE DETECTION OF HIGH-GRADE PROSTATE CANCER Avi S. Baskin, Claire de la Calle, Vittorio Fasulo, Janet Cowan, Peter E. Lonergan, Martina Maggi, Adam Gadzinski, Reuben Au Yeung, Alberto Saita, Matthew Cooperberg, Peter R. Carroll, Katsuto Shinohara, and Hao G. Nguyen Avi S. BaskinAvi S. Baskin More articles by this author , Claire de la CalleClaire de la Calle More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Janet CowanJanet Cowan More articles by this author , Peter E. LonerganPeter E. Lonergan More articles by this author , Martina MaggiMartina Maggi More articles by this author , Adam GadzinskiAdam Gadzinski More articles by this author , Reuben Au YeungReuben Au Yeung More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Peter R. CarrollPeter R. Carroll More articles by this author , Katsuto ShinoharaKatsuto Shinohara More articles by this author , and Hao G. NguyenHao G. Nguyen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of biomarkers for prostate cancer (PCa) screening in combination with clinical parameters such as multiparametric MRI (mpMRI), PSA density (PSAD) and transrectal ultrasonography (TRUS) has yet to be defined. We aim to evaluate the clinical utility of 4Kscore with mpMRI, TRUS and PSAD in detecting high-grade PCa and avoiding unnecessary biopsies. METHODS: This is a retrospective study of a patient cohort with normal digital rectal exam (DRE) and PSA 2.5-20 referred to the University of California, San Francisco between 2016 and 2020 for biomarker based prostate cancer screening. High-grade PCa was defined as Gleason Grade group (GG)≥2. The frequency of avoided biopsies was determined as the number of negative tests divided by the total cohort. The frequency of missed GG≥2 PCa was determined as the number of false negative tests divided by all high-grade diagnoses. RESULTS: A total of 652 men met the inclusion criteria and of these 490 (75.2%) underwent TRUS, 465 (40.6%) had PSAD, 465 (71.3%) had mpMRI and 366 (56.1%) underwent biopsy. The mean age was 65.5 (SD 7.54) and the median PSA was 7.87 (IQR 4.8–9.0). The median 4Kscore was 15.0 (IQR 7–31). Limiting biopsy to men with a 4Kscore ≥7.5 would have avoided 13.1% of biopsies while missing 3.6% high grade PCa. 4Kscore ≥7.5 combined with PI-RADS ≥3 would have only missed 0.7% high grade PCa but only avoided 2.45% unnecessary biopsies. Combining 4Kscore ≥20 with PSAD ≥0.15 and PI-RADS ≥3 however would have led to only missing 2.2% high-grade PCa while avoiding 11.5% biopsies. Combining 4Kscore ≥7.5 with PSAD ≥0.15 and TRUS ≥2a would have also missed very few high-grade PCa while avoiding the use of mpMRI (Table 1). CONCLUSIONS: In this contemporary cohort, combining the 4Kscore and mpMRI would have helped detect almost all high-grade PCas but avoided few biopsies. Higher 4Kscore thresholds can be used in combination with TRUS, PSAD and mpMRI to avoid more biopsies while still missing very few high-grade PCas. Such screening algorithms are likely already widely used in clinical practice and should be validated with prospective trials. Source of Funding: This study was funded by the UCSF Goldberg-Benioff Program in Cancer Translational Biology © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e466-e467 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avi S. Baskin More articles by this author Claire de la Calle More articles by this author Vittorio Fasulo More articles by this author Janet Cowan More articles by this author Peter E. Lonergan More articles by this author Martina Maggi More articles by this author Adam Gadzinski More articles by this author Reuben Au Yeung More articles by this author Alberto Saita More articles by this author Matthew Cooperberg More articles by this author Peter R. Carroll More articles by this author Katsuto Shinohara More articles by this author Hao G. Nguyen More articles by this author Expand All Advertisement Loading ...