MP67-11 PROSTATE IMAGING (MULTI-PARAMETRIC MRI AND PROSTATE HISTOSCANNING™) COMPARED TO TRANSPERINEAL ULTRASOUND GUIDED BIOPSY FOR SIGNIFICANT PROSTATE CANCER RISK EVALUATION- THE PICTURE STUDY

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You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2014MP67-11 PROSTATE IMAGING (MULTI-PARAMETRIC MRI AND PROSTATE HISTOSCANNING™) COMPARED TO TRANSPERINEAL ULTRASOUND GUIDED BIOPSY FOR SIGNIFICANT PROSTATE CANCER RISK EVALUATION- THE PICTURE STUDY Lucy Simmons, Ana Kanthbalan, Hashim Uddin Ahmed, Caroline M. Moore, Shonit Punwani, Alex Freeman, Yipeng Hu, Dean Barrett, Susan Charman, Jan Van der Mullen, and Mark Emberton Lucy SimmonsLucy Simmons More articles by this author , Ana KanthbalanAna Kanthbalan More articles by this author , Hashim Uddin AhmedHashim Uddin Ahmed More articles by this author , Caroline M. MooreCaroline M. Moore More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Alex FreemanAlex Freeman More articles by this author , Yipeng HuYipeng Hu More articles by this author , Dean BarrettDean Barrett More articles by this author , Susan CharmanSusan Charman More articles by this author , Jan Van der MullenJan Van der Mullen More articles by this author , and Mark EmbertonMark Emberton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2078AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prostate cancer pathway does not routinely use imaging for disease detection. PICTURE is a single centre, ethics approved prospective validating cohort study which assesses the diagnostic performance of multi-parametric Magnetic Resonance Imaging (mp-MRI) and Prostate HistoScanning™ (PHS) (level 1 evidence). The primary objective of the PICTURE study is to assess the ability of the two imaging tests in ruling out clinically significant prostate cancer-defined as the presence of primary Gleason pattern 4 AND/OR a Maximum Cancer Core Length (MCCL) ≥6mm. METHODS PICTURE will recruit 280 men who have undergone previous TRUS biopsy but where diagnostic uncertainty remains. A planned interim analysis was carried out on 114 men. All men in the study undergo both index tests and the reference test, of transperineal template mapping biopsy Men are blinded to the index test results and both tests reported prospectively to ensure reporter blinding to the reference standard. Mp-MRI (T2W, Diffusion, Dynamic contrast) are conducted without endorectal coil and are reported using the ESUR 5-point likert scale for likelihood of clinically significant prostate cancer. Prostate HistoScanning is performed using transrectal ultrasound and reported using the embedded software; lesion significance will be defined using size criteria (≥1.3 cc, ≥0.5cc and ≥0.2cc). The study is powered to the paired analysis of each index test to the reference test on a patient level (whole-gland). RESULTS Interim results demonstrate that on whole-gland analysis using mp-MRI score of ≥3as ‘positive’, mp-MRI sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and area under receiver operating curve (AUC) for detection of clinically significant disease was 69%, 78%, 67%, 79% and 0.76, respectively. For detection of any cancer, sensitivity, specificity, PPV, NPV and AUC were 97%, 18%, 92%, 40% and 0.83, respectively. HistoScanning performed poorly. CONCLUSIONS Interim results of PICTURE suggest that mp-MRI may be a useful test in the pathway. The encouraging NPV for significant disease demonstrated might enable men with negative MRI’s to safely avoid further biopsy. Full study results are expected in 2014. Table 1: Index test performance characteristics for detection of clinically significant disease Sensitivity (CI) Specificity (CI) PPV (CI) NPV (CI) MRI score >/=3 as positive test 68.9 (53.4-81.8) 78.3 (66.7-87.3) 67.4 (52.0-80.5) 79.4 (67.9-83.3) MRI score >/=4 as positive test 48.9 (33.7-64.2) 87.0 (76.7-93.9) 71.0 (52.0-85.8) 72.3 (61.4-81.6) HistoScanning lesion volume >/= 0.5cc 95.6 (84.9-99.5) 0.0 (0.0-5.2) 38.4 (29.4-48.1) 0.0 (0.0-84.2) HistoScaninng lesion >/= 1.3cc 84.4 (70.5-93.5) 5.8 (1.6-14.2) 36.9 (27.6-47.0) 36.4 (10.9-69.2) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e753 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lucy Simmons More articles by this author Ana Kanthbalan More articles by this author Hashim Uddin Ahmed More articles by this author Caroline M. Moore More articles by this author Shonit Punwani More articles by this author Alex Freeman More articles by this author Yipeng Hu More articles by this author Dean Barrett More articles by this author Susan Charman More articles by this author Jan Van der Mullen More articles by this author Mark Emberton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...