PI-RADS Score Research Articles

Abstract 2301: Indications for systematic prostate biopsy in men with negative multi-parametric magnetic resonance imaging

Abstract Introduction: Multiparametric Magnetic Resonance Imaging (mpMRI) is a valuable tool in the prostate cancer diagnostic pathway, and MRI-influenced biopsy has been shown to be superior to systematic biopsy alone for detecting clinically significant prostate cancer (csPCa), defined as the presence of any Gleason ≥ 4. Negative predictive value of mpMRI for csPCa varies widely in published reports, with a median of approximately 88%. Counselling patients with negative mpMRI (PIRADS score <3)to decide whether or not to proceed with systematic biopsy or PSA monitoring could be challenging. Several studies have shown that a PSA density (PSAD) ≥ 0.15 is an indication for systematic biopsy. We analysed the clinical, radiological and pathological features of patients with negative mpMRI but csPca on systematic biopsy to identify other criteria that may inform the need for systematic biopsy when mpMRI is negative. Methods: For 18 months between Nov 2017 and May 2019, all men on our prostate diagnostic pathway with negative mpMRI were offered systematic biopsy. The criteria for pre-biopsy mpMRI was any man suitable for radical surgery or radiotherapy, plus one or more of PSA ≥ 3, palpable lesion on digital rectal examination, or family history of PCa in a first degree relative (father or brother). mpMRI was performed with a 1.5-Tesla magnet and included T2, DWI and DCE sequences. Systematic biopsy was TRUS-guided, with 8-16 biopsy cores. Results: Of 589 mpMRI scans in 573 men, 216 (37%) had negative mpMRI. Of these, 141 (65%) proceeded with systematic biopsy. Among the men that had biopsy, Gleason 3+3 was detected in 12 men (9%) and Gleason ≥ 4 in six (4%). Important pre-biopsy features in men with Gleason ≥ 4 were PSAD ≥ 0.15 (n=3), artefact on MRI from hip joint prosthesis (n=1), and family history (n=2). There were no unusual histological variants seen on the positive biopsy cores. Conclusion: Most men with negative mpMRI can avoid prostate biopsy and be managed with PSA monitoring. Based on our experience, we recommend systematic biopsy in men with negative mpMRI who have PSAD ≥ 1.5, family history or any imaging artifact that may alter image interpretation. Citation Format: Chidi N. Molokwu, Christos Gkikas, Harry Bardgett, Nicola Lee, Faisal Ali, Rohit Chahal, Rajindra Singh. Indications for systematic prostate biopsy in men with negative multi-parametric magnetic resonance imaging [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2301.

A radiomics machine learning-based redefining score robustly identifies clinically significant prostate cancer in equivocal PI-RADS score 3 lesions

PI-RADS score 3 is recognized as equivocal likelihood of clinically significant prostate cancer (csPCa) occurrence. We aimed to develop a Radiomics machine learning (RML)-based redefining score to screen out csPCa in equivocal PI-RADS score 3 category. Total of 263 patients with the dominant index lesion scored PI-RADS 3 who underwent biopsy and/or follow-up formed the primary cohort. One-step RML (RML-i) model integrated radiomic features of T2WI, DWI, and ADC images all together, and two-step RML (RML-ii) model integrated the three independent radiomic signatures from T2WI (T2WIRS), DWI (DWIRS), and ADC (ADCRS) separately into a regression model. The two RML models, as well as T2WIRS, DWIRS, and ADCRS, were compared using the receiver operating characteristic-derived area under the curve (AUC), calibration plot, and decision-curve analysis (DCA). Two radiologists were asked to give a subjective binary assessment, and Cohen's kappa statistics were calculated. A total of 59/263 (22.4%) csPCa were identified. Inter-reader agreement was moderate (Kappa = 0.435). The AUC of RML-i (0.89; 95% CI 0.88-0.90) is higher (p = 0.003) than that of RML-ii (0.87; 95% CI 0.86-0.88). The DCA demonstrated that the RML-i and RML-ii significantly improved risk prediction at threshold probabilities of csPCa at 20% to 80% compared with doing-none or doing-all by PI-RADS score 3 or stratifying by separated DWIRS, ADCRS, or T2WIRS. Our RML models have the potential to predict csPCa in PI-RADS score3 lesions, thus can inform the decision making process of biopsy.

A Comparative Study of Prostate Cancer Detection Rate Between Transperineal COG-TB and Transperineal FUS-TB in Patients with PSA ≤20 ng/mL.

Background: The combination of prebiopsy MRI and transperineal targeted biopsies is being increasingly used to obtain tissues from patients with suspected prostate cancer (PCa). Objective: To investigate the difference in PCa detection rate between transperineal cognitive fusion TB (COG-TB) and transperineal software fusion TB (FUS-TB). Participants: The present study included 163 male patients with suspected PCa who had not undergone prostate biopsy, had a prostate-specific antigen (PSA) level of ≤20 ng/mL, and had been examined by bi-parameter MRI and confirmed to have prostate nodules by prostate imaging reporting and data system version 2 (PI-RADS V2) scores ≥3 (from December 3, 2018 to October 7, 2019). Intervention: Seventy-one patients underwent transperineal COG-TB, and 92 patients underwent transperineal FUS-TB. The detection rate of the first four needles was compared. Results: No significant difference was found in the overall detection rate of PCa between COG-TB and FUS-TB (60.56% vs 51.08%, p = 0.228). This result was consistent even after stratifying by PI-RADS score. There was also no significant difference between COG-TB and FUS-TB in the detection rate of clinically significant PCa (p = 0.641). Moreover, COG-TB and FUS-TB showed no difference in the detection rate of PCa with different Gleason scores. Conclusions: In patients with suspected PCa with PSA ≤20 ng/mL and PI-RADS ≥3, FUS-TB was comparable to COG-TB in the detection rate of PCa.

PI-RADS® Category as a Predictor of Progression to Unfavorable Risk Prostate Cancer in Men on Active Surveillance.

We identified baseline imaging and clinical characteristics of patients that may improve risk stratification among patients being evaluated for active surveillance. From July 2007 to January 2020 patients referred to our institution for prostate cancer were evaluated and those who remained on active surveillance were identified. Men underwent multiparametric magnetic resonance imaging upon entry into our active surveillance protocol during which baseline demographic and imaging data were documented. Patients were then followed and outcomes, specifically progression to Gleason Grade Group (GG)3 or greater disease, were recorded. Of the men placed on active surveillance 344 had at least 1 PI-RADS score documented. For those with an index lesion PI-RADS category of 5, 33% (17/51) had progression to GG3 or greater on active surveillance with a median time to progression of 31 months. When comparing the progression-free survival times and progression rates in each category, PI-RADS category was found to be associated with progression to GG3 or greater on active surveillance (p <0.01). On univariable analysis factors associated with progression included an index lesion PI-RADS category of 5, prostate specific antigen density and the size of the largest lesion. On multivariable analysis only PI-RADS category of 5 and prostate specific antigen density were associated with progression on active surveillance. PI-RADS lesion categories at baseline multiparametric magnetic resonance imaging during active surveillance enrollment can be used to predict cancer progression to GG3 or greater on active surveillance. This information, along with other clinical data, can better assist urologists in identifying and managing patients appropriate for active surveillance.

PI-RADS score v.2 in predicting malignancy in patients undergoing 5α-reductase inhibitor therapy.

To investigate if the PI-RADS score represents an effective tool in detecting prostate cancer in patients treated with a 5α-reductase inhibitor (dutasteride) and to identify dedicated total serum PSA and PSA density thresholds. Between April 2015 and March 2018, 75 patients under dutasteride treatment underwent multi-parametric magnetic resonance imaging (mpMRI) scans and US/MRI fusion prostate biopsy. Lesions were classified into two groups: Group 1 included PI-RADS 4 and 5 lesions, whilst Group 2 included PI-RADS 3-4-5 lesions. Lesions in groups 1 and 2 were further divided according to the patients' history of previous prostate biopsy. Ninety-seven lesions were detected. In PI-RADS 4-5 group, mpMRI showed a sensitivity of 78.0% and a specificity of 78.7%. The positive predictive value (PPV) was 79.6% and the negative predictive value (NPV) 77.1%. In PI-RADS 3-4-5 group, sensitivity was 100%, specificity 21.3%, PPV 57.5%, NPV 100%. In PI-RADS 4-5 biopsy-naive group sensitivity was 71.4%, specificity 75.0%. PPV 78.9% and NPV 66.7%. In PI-RADS 4-5 non-biopsy-naive group sensitivity was 82.8%, specificity 80.6%, PPV 80%, and NPV 83.3%. PI-RADS 3-4-5 biopsy-naive group showed sensitivity 100%, specificity 31.3%, PPV 65.6%, NPV 100%. PI-RADS 3-4-5 non-biopsy-naive group showed sensitivity 100%, specificity 16.1%, PPV 52.7%, and NPV 100%. ROC curve analysis indicated a serum total PSA threshold of 6 ng/ml (AUC: 0.71-95% confidence interval: 0.60-0.81) and a PSA density >0.22 (AUC: 0.70-95% confidence interval: 0.6-0.81) as optimal cut-offs for recommending prostate biopsy. In our experience the PI-RADS score proved to be sufficiently accurate in predicting prostate cancer in patients under dutasteride therapy.

3-T Multiparametric MRI Followed by In-Bore MR-Guided Biopsy for Detecting Clinically Significant Prostate Cancer After Prior Negative Transrectal Ultrasound-Guided Biopsy.

OBJECTIVE. The purpose of this study was to evaluate the rate of detection of clinically significant prostate cancer (csPCa), as assessed on the basis of Prostate Imaging Reporting and Data System version 2.1 (PI-RADSv2.1) guidelines, using 3-T in-bore MR-guided biopsy (MRGB) for a cohort of patients suspected of having csPCa despite having a history of recent negative transrectal ultrasound-guided biopsy results. MATERIALS AND METHODS. The cohort in this retrospective, single-center study was derived from a database of 330 patients who underwent multiparametric MRI (mpMRI) followed by in-bore transrectal 3-T MRGB. Seventy-nine patients (mean [± SD] age, 64.1 ± 8.6 years) with prior negative transrectal ultrasound-guided biopsy results and positive pre-MRGB mpMRI results (PI-RADS score ≥ 3) composed the final cohort. The rate of detection of PCa and csPCa (the latter of which was defined by a Gleason score of 3 + 4 or higher) was stratified according to updated PI-RADSv2.1 assessment. RESULTS. MRGB detected PCa in 36 patients (45.6%), 30 (83.3%) of whom had csPCa. The PI-RADSv2.1 score was a strong predictor (odds ratio, 3.97; 95% CI, 1.93-7.47) of csPCa detection. We found two benign transition zone target lesions that were downgraded from PI-RADSv2 category 3 to PI-RADSv2.1 category 2. PCa was detected in 18.4% (7/38), 65.2% (15/23), and 87.5% (14/16) of individuals with PI-RADSv2.1 category 3, 4, and 5 lesions, respectively, with 85.7% (6/7), 86.7% (13/15), and 78.6% (11/14) of these cases found to be csPCa, respectively. Of the seven PI-RADSv2.1 category 3 csPCa lesions, six had prostate-specific antigen density greater than 0.10 ng/mL/cc. CONCLUSION. With the use of 3-T in-bore MRGB, csPCa was detected in 38% of individuals with prior negative transrectal ultrasound-guided biopsy results. PI-RADSv2.1 was a strong predictor of csPCa detection. On the basis of our results, patients with PI-RADSv2.1 category 4 or 5 lesions and patients with PI-RADSv2.1 category 3 lesions and a prostate-specific antigen density greater than or equal to 0.10 ng/mL/cc may benefit from in-bore MRGB.

Can the combination of biparametric magnetic resonance imaging and PSA-related indicators predict the prostate biopsy outcome?

To assess the value of biparametric magnetic resonance imaging (bpMRI) for detecting and ruling out prostate cancer in patients with elevated prostate-specific antigen (PSA). The basic information and bpMRI images of enrolled patients who took transperineal template saturate biopsy were retrospectively collected for analysis. Based on our results, we found that free/total PSA, and PI-RADS score were independent risk factors of PCa (p<.05), the PSA density, PI-RADS score were the independent risk factors of csPCa (p<.05). PI-RADS score threshold of 3 could achieve the highest Yonder index for predicting PCa, and PI-RADS score threshold of 4 could achieve the highest Yonder index for predicting csPCa. Therefore, we draw a conclusion that PI-RADSv2 score-based bpMRI could diminish the unnecessary prostate biopsies in patients with elevated PSA when combined with other PSA-related indicators.

The efficacy of multiparametric prostate magnetic resonance imaging in the diagnosis and treatment of prostate cancer

Aim: To investigate the accuracy of multiparametric prostate magnetic resonance imaging (mpMRI) in determining the diagnosis and treatment options of prostate cancer (PCa), and its pathology correlation. Methods: Between October 2017 and January 2018, 73 patients were subjected to an mpMRI at our clinic. Of these patients, 11 were radical prostatectomy (RP) after treatment, and four were post- radiation therapy (RT) follow-up. The remaining 58 patients were assigned to the PSA elevation and / or positive digital rectal examination (DRE) patient group in this study and their outcomes were evaluated. Results: Of the 58 patients included in the study, 13 were found to have a PI-RADS 5 on mpMRI and in 9 (90%) of 10 patients undergoing simultaneous biopsy, PCa was detected. The biopsy results of all cases evaluated as PI-RADS 1 were benign. All of the patients who were ISUP 3 and above had a PI-RADS 5. Patients with a PI-RADS score of 4 and above being ISUP 2 and above was statistically significant (p=0.011). A case had undergone a previous radical prostatectomy assessment revealed that tPSA increased to 2 ng/ml during the follow-up, and so RT was added to the treatment; although LAP was identified in the left iliac region on an mpMRI performed upon the continued increase of tPSA. During the follow-ups of the patient who had regional RT, the tPSA dropped below 0.01 ng/ml. Conclusion: The results of our study show that mpMRI can gain a new and important place in urology due to the guidance it provides in biopsies, facilitating targeted biopsy, its effectiveness in determining treatment modalities and its importance in post-PCa treatment follow-ups.

1034 - Prognostic value of high PIRADS score lesions at mp-MRI of the prostate in men with low risk prostate cancer managed with active surveillance: Results from a single institution series

1034 - Prognostic value of high PIRADS score lesions at mp-MRI of the prostate in men with low risk prostate cancer managed with active surveillance: Results from a single institution series

1033 - Are men with low risk prostate cancer but high PIRADS score lesions at mp-MRI still candidate for active surveillance? Results from a large, multi-institutional radical prostatectomy series

1033 - Are men with low risk prostate cancer but high PIRADS score lesions at mp-MRI still candidate for active surveillance? Results from a large, multi-institutional radical prostatectomy series

Clinically significant prostate cancer detection and segmentation in low-risk patients using a convolutional neural network on multi-parametric MRI

ObjectivesTo develop an automatic method for identification and segmentation of clinically significant prostate cancer in low-risk patients and to evaluate the performance in a routine clinical setting.MethodsA consecutive cohort (n = 292) from a prospective database of low-risk patients eligible for the active surveillance was selected. A 3-T multi-parametric MRI at 3 months after inclusion was performed. Histopathology from biopsies was used as reference standard. MRI positivity was defined as PI-RADS score ≥ 3, histopathology positivity was defined as ISUP grade ≥ 2. The selected cohort contained four patient groups: (1) MRI-positive targeted biopsy-positive (n = 116), (2) MRI-negative systematic biopsy-negative (n = 55), (3) MRI-positive targeted biopsy-negative (n = 113), (4) MRI-negative systematic biopsy-positive (n = 8). Group 1 was further divided into three sets and a 3D convolutional neural network was trained using different combinations of these sets. Two MRI sequences (T2w, b = 800 DWI) and the ADC map were used as separate input channels for the model. After training, the model was evaluated on the remaining group 1 patients together with the patients of groups 2 and 3 to identify and segment clinically significant prostate cancer.ResultsThe average sensitivity achieved was 82–92% at an average specificity of 43–76% with an area under the curve (AUC) of 0.65 to 0.89 for different lesion volumes ranging from > 0.03 to > 0.5 cc.ConclusionsThe proposed deep learning computer-aided method yields promising results in identification and segmentation of clinically significant prostate cancer and in confirming low-risk cancer (ISUP grade ≤ 1) in patients on active surveillance.Key Points• Clinically significant prostate cancer identification and segmentation on multi-parametric MRI is feasible in low-risk patients using a deep neural network.• The deep neural network for significant prostate cancer localization performs better for lesions with larger volumes sizes (> 0.5 cc) as compared to small lesions (> 0.03 cc).• For the evaluation of automatic prostate cancer segmentation methods in the active surveillance cohort, the large discordance group (MRI positive, targeted biopsy negative) should be included.

Multiparametric magnetic resonance imaging and clinical variables: Which is the best combination to predict reclassification in active surveillance patients?

Introduction & objectivesWe tested the role of multiparametric magnetic resonance imaging (mpMRI) in disease reclassification and whether the combination of mpMRI and clinicopathological variables could represent the most accurate approach to predict the risk of reclassification during active surveillance.Materials & methodsThree-hundred eighty-nine patients (pts) underwent mpMRI and subsequent confirmatory or follow-up biopsy according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol. Pts with negative (−) mpMRI underwent systematic random biopsy. Pts with positive (+) mpMRI [Prostate Imaging Reporting and Data System, version 2 (PI-RADS-V2) score ≥3] underwent targeted + systematic random biopsies. Multivariate analyses were used to create three models predicting the probability of reclassification [International Society of Urological Pathology ≥ Grade Group 2 (GG2)]: a basic model including only clinical variables (age, prostate-specific antigen density, and number of positive cores at baseline), an Magnetic resonance imaging (MRI) model including only the PI-RADS score, and a full model including both the previous ones. The predictive accuracy (PA) of each model was quantified using the area under the curve.ResultsmpMRI negative (−) was recorded in 127 (32.6%) pts; mpMRI positive (+) was recorded in 262 pts: 72 (18.5%) had PI-RADS 3, 150 (38.6%) PI-RADS 4, and 40 (10.3%) PI-RADS 5 lesions. At a median follow-up of 12 months, 125 pts (32%) were reclassified to GG2 prostate cancer. The rate of reclassification to GG2 prostate cancer was 17%, 35%, 38%, and 52% for mpMRI (−), PI-RADS 3, 4, and 5, respectively (P < 0.001). The PA was 69% and 64% in the basic and MRI models, respectively. The full model had the best PA of 74%: older age (P = 0.023; Odds ratio (OR) = 1.040), prostate-specific antigen density (P = 0.037; OR = 1.324), number of positive cores at baseline (P = 0.001; OR = 1.441), and PI-RADS 3, 4, and 5 (overall P = 0.001; OR = 2.458, 3.007, and 3.898, respectively) were independent predictors of reclassification.ConclusionsDisease reclassification increased according to the PI-RADS score increase, at confirmatory or follow-up biopsy. However, a no-negligible rate of reclassification was found also in cases of mpMRI (−). The combination of mpMRI and clinicopathological variables still represents the most accurate approach to pts on active surveillance.

External validation of the Briganti nomogram predicting lymph node invasion in patients with intermediate and high-risk prostate cancer diagnosed with magnetic resonance imaging-targeted and systematic biopsies: A European multicenter study

ObjectiveTo validate a nomogram predicting lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy taking into consideration multiparametric-magnetic resonance imaging (mp-MRI) parameters and targeted biopsies in a western European cohort. Patients and MethodsA total of 473 men diagnosed by targeted biopsies, using software-based MRI-ultrasound image fusion system, and operated by radical prostatectomy with extended pelvic lymph node dissection across 11 Europeans centers between 2012 and 2019 were identified. Area under the curve of the receiver operator characteristic curve, calibration plot and decision curve analysis were used to evaluated the performance of the model. ResultsOverall, 56 (11.8%) patients had LNI on final pathologic examination with a median (IQR) of 13 (9–18) resected nodes. Significant differences (all P < 0.05) were found between patients with and without LNI in terms of preoperative PSA, clinical stage at DRE and mp-MRI, maximum diameter of the index lesion, PI-RADS score, Grade Group on systematic and targeted biopsies, total number of dissected lymph nodes, final pathologic staging and Grade Group. External validation of the prediction model showed a good accuracy with an area under the curve calculated as 0.8 (CI 95% 0.75–0.86). Graphic analysis of calibration plot and decision curve analysis showed a slight underestimation for predictive probability for LNI between 3% and 22% and a high net benefit. A cut-off at 7% was associated with a risk of missing LNI in 2.6%, avoiding unnecessary surgeries in 55.9%. ConclusionsWe report an external validation of the nomogram predicting LNI in patients treated with extended pelvic lymph node dissection in a western European cohort and a cut-off at 7% seems appropriate.

Population-based prostate cancer screening using a prospective, blinded, paired screen-positive comparison of PSA and fast MRI: The IP1-PROSTAGRAM study.

5513 Background: The prostate-specific antigen (PSA) test can lead to under- and over-diagnosis of prostate cancer and has not been recommended for population screening. A fast MRI scan might overcome the limitations of PSA. IP1-PROSTAGRAM is the first study to evaluate the performance of a 15-minute non-contrast MRI for prostate cancer screening in comparison to PSA. Methods: IP1-PROSTAGRAM was a prospective, population-based, screen-positive paired-cohort study. Men aged 50-69 years in the UK were invited for prostate cancer screening through seven primary care practices or community-based recruitment. Participants underwent a PSA and MRI scan (T2-weighted and diffusion). MRI was scored using PIRADS version 2.0 without knowledge of PSA; screen-positive MRI (defined as either PIRADS score 3-5 or 4-5) were compared against a screen-positive PSA defined as ≥3ng/ml. If any test was screen-positive, a systematic 12-core biopsy was performed with MRI-ultrasound image-fusion targeted biopsy to MRI suspicious areas, as appropriate. Clinically-significant cancer was defined as any Gleason score ≥3+4. The primary outcome was the proportion of screen-positive MRI at different scores; important secondary outcomes were the number of clinically-significant and insignificant cancers detected. Results: 2034 men were invited to participate of whom 408 consented and 406 were screened by both PSA and MRI (10/Oct/2018-15/May/2019). The proportion with a screen-positive MRI (score 3-5) was higher than the proportion with a screen-positive PSA (17.7% [95%CI 14.3-21.8] vs. 9.9% [95%CI 7.3-13.2]; p &lt; 0.001). A screen-positive MRI (score 4-5) was similar to a screen-positive PSA (10.6% [95%CI 7.9-14.0] vs. 9.9% [95%CI 7.3-13.2], p = 0.71). An MRI score 3-5 or 4-5 used to denote a screen-positive MRI, compared to PSA alone, detected 14, 11 and 7 clinically-significant cancers, respectively. There were 7, 5 and 6 clinically-insignificant cancers detected, respectively. No serious adverse events occurred. Conclusions: When screening the general population for prostate cancer, MRI using a score of 4-5 to define a screen-positive test, compared to PSA alone at ≥3ng/ml, could lead to more men diagnosed with clinically-significant cancer without increasing the number of men biopsied or diagnosed with clinically-insignificant cancer. Clinical trial information: NCT03702439 .

Prediction of prostate cancer Gleason score upgrading from biopsy to radical prostatectomy using pre-biopsy multiparametric MRI PIRADS scoring system

An increase or ‘upgrade’ in Gleason Score (GS) in prostate cancer following Transrectal Ultrasound (TRUS) guided biopsies remains a significant challenge to overcome. to evaluate whether MRI has the potential to narrow the discrepancy of histopathological grades between biopsy and radical prostatectomy, three hundred and thirty men treated consecutively by laparoscopic radical prostatectomy (LRP) between July 2014 and January 2019 with localized prostate cancer were included in this study. Independent radiologists and pathologists assessed the MRI and histopathology of the biopsies and prostatectomy specimens respectively. A multivariate model was constructed using logistic regression analysis to assess the ability of MRI to predict upgrading in biopsy GS in a nomogram. A decision-analysis curve was constructed assessing impact of nomogram using different thresholds for probabilities of upgrading. PIRADS scores were obtained from MRI scans in all the included cases. In a multivariate analysis, the PIRADS v2.0 score significantly improved prediction ability of MRI scans for upgrading of biopsy GS (p = 0.001, 95% CI [0.06–0.034]), which improved the C-index of predictive nomogram significantly (0.90 vs. 0.64, p < 0.05). PIRADS v2.0 score was an independent predictor of postoperative GS upgrading and this should be taken into consideration while offering treatment options to men with localized prostate cancer.

A PI-RADS-Based New Nomogram for Predicting Clinically Significant Prostate Cancer: A Cohort Study.

PurposeTo develop and validate a PI-RADS-based nomogram for predicting the probability of clinically significant prostate cancer (csPCa) at initial prostate biopsy.Patients and MethodsFrom February 2015 to October 2018, 573 consecutive patients made up the development cohort (DC), and another 253 patients were included as an independent validation cohort (VC). Univariate and multivariate analysis were used for determining the dependent clinical risk factors for csPCa. Prediction model1 was constructed by integrating independent clinical risk factors. Then added the PI-RADS score to model1 to develop the prediction model2 and present it in the form of a nomogram. The performance of the nomogram was assessed by receiver operating characteristic curve, net reclassification improvement analysis, calibration curve, and decision curve.ResultsAll clinical candidate factors were significantly different between csPCa and non-csPCa in both the DC and VC. Age, PSA density (PSAD), and free-to-total PSA ratio (f/t) were ultimately determined as dependent clinical risk factors for csPCa and integrated into prediction model1. Then, prediction model2 was developed and presented in a nomogram. In the DC, the nomogram (AUC=0.894) was superior to model1, PI-RADS score, or other clinical factors alone in detecting csPCa. Similar result (AUC=0.891) was obtained in the VC. NRI analysis showed that the nomogram improved the classification of patients significantly compared with model1. Furthermore, the nomogram showed favorable calibration and great clinical usefulness.ConclusionThis study developed and validated a nomogram that integrates PI-RADS score with other independent clinical risk factors to facilitate prebiopsy individualized prediction in high-risk patients with csPCa.

Impact of mandated prospectively reported apparent diffusion coefficient values on the rates of positivity for clinically significant prostate cancer by PI-RADS score.

Prior research has shown that retrospectively measured apparent diffusion coefficient (ADC) of prostate magnetic resonance imaging (MRI) lesions is associated with clinically significant prostate cancer (csPCa) on targeted biopsy suggesting that ADC should be measured and reported prospectively. To assess the impact of mandatory prospective measurement of ADC on the rates of positivity across PI-RADS scores for csPCa. Consecutive patients who underwent ultrasound (US)-MRI fusion prostate biopsy from August 2018 to July 2019 and who had prospectively reported ADC were compared to control patients who did not. Rates of positivity by PI-RADS category were computed and compared using Chi-square. Multivariable regression was performed. In total, 126 patients (median age 65 years) with 165 prostate lesions (19, 51, 70, and 25 PI-RADS 2, 3, 4, and 5, respectively) and prospectively reported ADC values were compared to 113 control patients (median age 66 years) with 157 prostate lesions (17, 42, 64, and 34 PI-RADS 2, 3, 4, and 5, respectively). Rates of positivity across PI-RADS scores were similar between the two cohorts; 11%, 25%, 55%, and 76% and 0%, 21%, 56%, and 62% for PI-RADS 2, 3, 4, and 5 in the test and control cohorts, respectively (Chi-square P = 0.78). Multivariate logistic regression showed no significant association between the presence of prospectively measured ADC and csPCa (odds ratio 1.1, 95% confidence interval 0.7-1.7, P = 0.82). Prospective ADC measurement may not impact PI-RADS category assignments or positivity rates for csPCa under current guidelines. Future versions of PI-RADS may need to incorporate ADC into scoring rules to realize their potential.

Evaluation of relationships between the final Gleason score, PI-RADS v2 score, ADC value, PSA level, and tumor diameter in patients that underwent radical prostatectomy due to prostate cancer.

This study aimed to investigate the relationship between the serum PSA level, Gleason score (GS), PI-RADS v2 score, tumor ADCmin value, and the largest tumor diameter in patients that underwent radical prostatectomy (RP) due to prostate cancer (PCa) and to comparatively evaluate the variables of these parameters in clinically significant and insignificant PCa groups. The mpMRI examinations of the patients who underwent RP due to PCa were retrospectively evaluated. According to the final GS, the lesions were divided into two groups as clinically significant (GS ≥ 7) and insignificant (GS ≤ 6). The PSA value, tumor ADCmin value, tumor diameter, and PI-RADS score were compared between the clinically significant and nonsignificant PCa groups using Student's t-test. The correlations between the serum PSA level, GS, PI-RADS v2 score, tumor ADCmin value, and tumor diameter were evaluated separately (Pearson's correlation analysis was used for peripheral gland tumors, and Spearman's correlation analysis for central gland tumors). A ROC analysis was undertaken to evaluate the efficacy of the tumor ADCmin, diameter and PSA values in differentiating clinically significant and nonsignificant tumors. In both central and peripheral gland tumors, there was a correlation between the PSA level, tumor diameter, PI-RADS score, ADCmin value, and GS at various levels (poor, moderate, and high). In central gland tumors, there was no significant difference between the two groups in terms of the PSA value and PI-RADS scores (p > 0.05), but the ADCmin value and diameter of the tumor significantly differed (p < 0.05). For peripheral gland tumors, significant differences were observed in all parameters (p < 0.05). The cut-off values for the peripheral and central gland tumors are as follows: lesion diameter, 13.5mm and 19mm; tumor ADCmin, 0.709 × 10-3mm2/s and 0.874 × 10-3mm2/s; and PSA level, 8.47ng/ml and 11.10ng/ml, respectively. The current PI-RADS v2 scoring system can be inadequate in distinguishing clinically significant and insignificant groups in central gland tumors. A separate cut-off value of the tumor diameter should be determined for central and peripheral gland tumors. Tumor ADCmin values can be used as a predictive parameter. The PSA cut-off value should be kept lower in peripheral gland tumors.

MP13-09 PRE-BIOPSY MULTIPARAMTRIC MR IMAGING USING PI-RADS SCORING SYSTEM SIGNIFICANTLY PREDICT UPGRADING OF RANDOM TRANSRECTAL PROSTATE BIOPSIES GRADING FOLLOWING RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVE: An increase or ‘upgrade’ in Gleason Score (GS) in prostate cancer following Transrectal Ultrasound (TRUS) guided biopsies remains a significant challenge to overcome. To evaluate whether pre-biopsy magnetic resonance imaging (MRI) has the potential to narrow the discrepancy of histopathological grades between TRUS biopsy and radical prostatectomy using Prostate Imaging Reporting and Data System version 2 (PIRADS v2.0). METHODS: Three hundred and thirty men treated consecutively by laparoscopic radical prostatectomy (LRP) between July 2013 and January 2019 with localised prostate cancer were included in this study. All the participants had a pre-biopsy 3T-MRI scan followed by TRUS biopsies. An independent radiologist and pathologist assessed the PIRADS scoring of the MRI and histopathology of the biopsies and prostatectomy specimens respectively. An improved orientation between imaging and histopathology was achieved by using 3-D fabricated moulds to direct histopathological grossing. A multivariate model was constructed using logistic regression analysis to assess the ability of PIRADS v2.0 score to predict upgrading in TRUS biopsy GS in a nomogram. A decision-analysis curve was constructed assessing impact of nomogram using different thresholds for probabilities of upgrading. RESULTS: Eight men were excluded for analysis for various reasons. PIRADS scores were obtained from MRI scans in all the included cases. Of the remaining 322 patients, 101/322 (31%) experienced histopathological upgrading on LRP from TRUS biopsies. Most of the participants with upgrading had high (≥ 4) PIRADS score (91/101; 90%). In a multivariate analysis, the PIRADS score significantly improved prediction ability of pre-biopsy MRI scans for upgrading of TRUS biopsy GS (p=0.001, 95% CI [0.06-0.034]), which improved the C-index of predictive nomogram significantly (0.90 vs. 0.64, p<0.05). CONCLUSIONS: PIRADS v2.0 score is an independent predictor of postoperative GS upgrading and this should be taken into consideration while offering treatment options to men with localised prostate cancer. Source of Funding: No Funding

MP42-14 PI-RADS CATEGORIES ON INITIAL PROSTATE MRI ARE ASSOCIATED WITH ACTIVE SURVEILLANCE PROGRESSION IN PATIENTS WITH PROSTATE CANCER

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP42)1 Apr 2020MP42-14 PI-RADS CATEGORIES ON INITIAL PROSTATE MRI ARE ASSOCIATED WITH ACTIVE SURVEILLANCE PROGRESSION IN PATIENTS WITH PROSTATE CANCER Alex Z. Wang*, Luke P. O'Connor, Nitin Yerram, MD Jonathan Zeng, Sherif Mehralivand, MD Stephanie Harmon, PhD Amir H. Lebastchi, MD Michael Ahdoot, MD Siobhan Telfer, MD Patrick H. Gomella, MD Sandeep Gurram, MD Heather Chalfin, MD Naveen Nandanan, MD Peter L. Choyke, MD Maria J. Merino, MD Bradford J. Wood, MD Baris Turkbey, and Peter A. PintoMD Alex Z. Wang*Alex Z. Wang* More articles by this author , Luke P. O'ConnorLuke P. O'Connor More articles by this author , Nitin YerramNitin Yerram More articles by this author , Jonathan ZengJonathan Zeng More articles by this author , Sherif MehralivandSherif Mehralivand More articles by this author , Stephanie HarmonStephanie Harmon More articles by this author , Amir H. LebastchiAmir H. Lebastchi More articles by this author , Michael AhdootMichael Ahdoot More articles by this author , Siobhan TelferSiobhan Telfer More articles by this author , Patrick H. GomellaPatrick H. Gomella More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Heather ChalfinHeather Chalfin More articles by this author , Naveen NandananNaveen Nandanan More articles by this author , Peter L. ChoykePeter L. Choyke More articles by this author , Maria J. MerinoMaria J. Merino More articles by this author , Bradford J. WoodBradford J. Wood More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , and Peter A. PintoPeter A. Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000891.014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active Surveillance (AS) is now a popular and well-accepted alternative to definitive therapy in patients with low-favorable to intermediate risk prostate cancer (PCa). Multiparametric MRI (mpMRI) is one of the tools frequently used to monitor progression in patients with CaP. Prostate Imaging Reporting & Data System (PI-RADS) scores are assigned to assess risk of clinically significant prostate cancer (csPCa). In this study, we investigate if PI-RADS scores are associated with AS progression for patients. METHODS: Our institutional database was queried for all patients who met criteria for active surveillance from 11/2003 to 5/2017. Criteria for inclusion included ≥ 2 mpMRIs, ≥ 2 prostate biopsies, and a diagnosis of prostate cancer. Patient demographics, mpMRI, biopsy and most recent follow-up data were recorded. PI-RADS categories on initial MRI were evaluated for eventual AS progression. RESULTS: 1709 patients were evaluated for prostate cancer at our institution. A total of 351 patients met the criteria for AS. 162 patients with PIRADS scores on initial MRI were selected. The average PSA at time of AS enrollment was 7.15 ng/mL (range, 0.06-96.76). 47/162 patients (29%) were recorded to have progressed on AS during this time. The median time to AS progression was 4.13 years (range, 0.05-10.4). Results are listed in Table 1. Of interest, 55/162 patients were found to have a PI-RADS 4 index lesion and 20/55 (36%) of these patients progressed on AS, with a mean time to progression of 4.12 years (IQR 2.53-5.84). A total of 19/162 patients were found to have a PI-RADS 5 index lesion and 9/19 (47%) of these patients progressed on AS with a mean time to progression of 2.22 years (IQR 1.55-2.01). On multivariable analysis, only PI-RADS category 4 or higher lesions (HR, 1.931; 95% CI, 1.037-3.595; p=0.04) were associated with progression on AS. CONCLUSIONS: PI-RADS category 4 lesions or higher on initial mpMRI can be used to predict progression of csCaP with patients on AS. Urologists should consider patients with PI-RADS 4 lesions high risk in any AS protocol and be monitored very closely. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e609-e609 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Z. Wang* More articles by this author Luke P. O'Connor More articles by this author Nitin Yerram More articles by this author Jonathan Zeng More articles by this author Sherif Mehralivand More articles by this author Stephanie Harmon More articles by this author Amir H. Lebastchi More articles by this author Michael Ahdoot More articles by this author Siobhan Telfer More articles by this author Patrick H. Gomella More articles by this author Sandeep Gurram More articles by this author Heather Chalfin More articles by this author Naveen Nandanan More articles by this author Peter L. Choyke More articles by this author Maria J. Merino More articles by this author Bradford J. Wood More articles by this author Baris Turkbey More articles by this author Peter A. Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...