MultiParametric Magnetic Resonance Imaging-Based Nomogram for Predicting Prostate Cancer and Clinically Significant Prostate Cancer in Men Undergoing Repeat Prostate Biopsy.

Cong Huang,Gang Song,Zhongcheng Xin,Yuke Chen,Yu Fan,He Wang,Liqun Zhou,Gengyan Xiong,Jie Li,Guangjie Ji,Dong Fang

doi:10.1155/2018/6368309

Abstract

Objective To develop and internally validate nomograms based on multiparametric magnetic resonance imaging (mpMRI) to predict prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in patients with a previous negative prostate biopsy. Materials and Methods The clinicopathological parameters of 231 patients who underwent a repeat systematic prostate biopsy and mpMRI were reviewed. Based on Prostate Imaging and Reporting Data System, the mpMRI results were assigned into three groups: Groups “negative,” “suspicious,” and “positive.” Two clinical nomograms for predicting the probabilities of PCa and csPCa were constructed. The performances of nomograms were assessed using area under the receiver operating characteristic curves (AUCs), calibrations, and decision curve analysis. Results The median PSA was 15.03 ng/ml and abnormal DRE was presented in 14.3% of patients in the entire cohort. PCa was detected in 75 patients (32.5%), and 59 (25.5%) were diagnosed with csPCa. In multivariate analysis, age, prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE), and mpMRI finding were significantly independent predictors for PCa and csPCa (all p < 0.01). Of those patients diagnosed with PCa or csPCa, 20/75 (26.7%) and 18/59 (30.5%) had abnormal DRE finding, respectively. Two mpMRI-based nomograms with super predictive accuracy were constructed (AUCs = 0.878 and 0.927, p < 0.001), and both exhibited excellent calibration. Decision curve analysis also demonstrated a high net benefit across a wide range of probability thresholds. Conclusion mpMRI combined with age, PSA, PV, and DRE can help predict the probability of PCa and csPCa in patients who underwent a repeat systematic prostate biopsy after a previous negative biopsy. The two nomograms may aid the decision-making process in men with prior benign histology before the performance of repeat prostate biopsy.

Highlights

Unlike other genitourinary tumours, prostate cancer (PCa) is often multifocal and heterogeneous and presents a challenge with regard to identifying malignant regions [1]
Due to the limitations of prostate-specific antigen (PSA) associated with its noncancer specificity [4], the development of predictive models such as nomograms is of great interest
After obtaining appropriate Institutional Review Board approval, we retrospectively reviewed the clinical data of 328 patients who underwent repeat transrectal ultrasound- (TRUS-) guided prostate biopsy after initial negative biopsy between January 2007 and April 2017 at our institution

Summary

Introduction

Prostate cancer (PCa) is often multifocal and heterogeneous and presents a challenge with regard to identifying malignant regions [1]. Despite advances in biopsy technology in recent decades, in approximately 60–70% of patients initial systematic prostate biopsy results are negative, due to the very limited or randomized sampling associated with the method [3]. In many of these patients a clinical suspicion of PCa persists, based on sustained elevated. BioMed Research International serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) findings and/or suspicious lesions on magnetic resonance imaging (MRI) This poses a significant clinical dilemma for urologists, who must endeavour to identify the patients with negative pathology results who may be more likely to have PCa, in order to schedule them for a repeat prostate biopsy. The utilization of these models for predicting PCa of subsequent biopsy has diminished over time, as screening has become more widespread in the general population

Methods

Results

Conclusion