You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-08 MRI, BIOMARKER, OR BOTH? RESULTS FROM A LARGE MULTI-INSTITUTIONAL STUDY OF 1111 MEN WITH 4KSCORE, MULTIPARAMETRIC MRI AND PROSTATE BIOPSY Venkatasai S Atluri, Ricardo Almeida, Issac Zucker, Isildinha M Reis, Deukwoo Kwon, Nachiket Soodana-Prakash, Ashutosh Tewari, Vipul Patel, Vinayak Wagaskar, Badrinath Konety, Ali Kasraeian, Stefan W. Czarniecki, Greg Thoreson, Eric Kim, and Sanoj Punnen Venkatasai S AtluriVenkatasai S Atluri More articles by this author , Ricardo AlmeidaRicardo Almeida More articles by this author , Issac ZuckerIssac Zucker More articles by this author , Isildinha M ReisIsildinha M Reis More articles by this author , Deukwoo KwonDeukwoo Kwon More articles by this author , Nachiket Soodana-PrakashNachiket Soodana-Prakash More articles by this author , Ashutosh TewariAshutosh Tewari More articles by this author , Vipul PatelVipul Patel More articles by this author , Vinayak WagaskarVinayak Wagaskar More articles by this author , Badrinath KonetyBadrinath Konety More articles by this author , Ali KasraeianAli Kasraeian More articles by this author , Stefan W. CzarnieckiStefan W. Czarniecki More articles by this author , Greg ThoresonGreg Thoreson More articles by this author , Eric KimEric Kim More articles by this author , and Sanoj PunnenSanoj Punnen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: mpMRI and biomarkers have emerged as helpful tools to evaluate the need for prostate biopsy, however uncertainty remains in which test to get first. We assessed the performance of mpMRI and the 4K score for detecting clinically significant prostate cancer and reducing unnecessary biopsies in a multi-institutional dataset. METHODS: We retrospectively evaluated men in 8 different institutions who were referred for prostate cancer evaluation and underwent mpMRI, 4Kscore and prostate biopsy. The primary outcome was the presence of grade group 2 or higher(GG2+)cancer. We compared the utilization of one test versus both using logistic regression, calibration plots, and decision curve analysis. Additionally, we compared using each test individually to various combinations and sequences of mpMRI and 4Kscore test and assessed the impact on biopsies avoided and cancers missed. RESULTS: Among 1111 men who underwent a 4Kscore, mpMRI and biopsy, 353 (31.8%) had GG2+ cancer. We found using both the tests together had a higher detection of GG2+cancer compared to using either test alone (mpMRI/4Kscore vs mpMRI: AUC 0.85 vs 0.77, p<0.001; mpMRI/4Kscore vs 4Kscore: AUC 0.85 vs 0.78, p<0.001). Using both tests also showed better calibration and higher net benefit compared to either test alone. Using both tests together allowed the least missed GG2+ cancers but avoided less biopsies. Using the tests in sequence allowed close to a third of patients to avoid biopsy, with similar rates of missed GG2+ cancer (Table 1). CONCLUSIONS: We used a large multi-institutional cohort of men who underwent mpMRI and 4Kscore and found that using both tests appeared to perform better than using either test alone. We did not find any difference between starting with an mpMRI versus a 4Kscore, but prospective studies are needed for further validation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e854-e855 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Venkatasai S Atluri More articles by this author Ricardo Almeida More articles by this author Issac Zucker More articles by this author Isildinha M Reis More articles by this author Deukwoo Kwon More articles by this author Nachiket Soodana-Prakash More articles by this author Ashutosh Tewari More articles by this author Vipul Patel More articles by this author Vinayak Wagaskar More articles by this author Badrinath Konety More articles by this author Ali Kasraeian More articles by this author Stefan W. Czarniecki More articles by this author Greg Thoreson More articles by this author Eric Kim More articles by this author Sanoj Punnen More articles by this author Expand All Advertisement Loading ...