Prediction Of Significant Prostate Cancer Research Articles

Prediction of significant prostate cancer in equivocal MRI lesions: A high-volume international multicenter study.

311 Background: The decision of performing prostate biopsy in men with equivocal findings in prostate magnetic resonance imaging (MRI) is challenging as they have a low but still relevant risk of harboring significant prostate cancer (sPC). Objective: To identify clinical predictors of sPC in men with equivocal findings in prostate MRI. Secondly, we aimed to analyze the hypothetical effect of incorporating prostate-specific antigen density (PSAD) into biopsy decision. Methods: We analysed a retrospective multinational cohort from 10 academic centers comprising 1476 men who underwent combined prostate biopsy (MRI-targeted plus systematic) between 02/2012 – 04/2021 due to an equivocal lesion found in prostate MRI (Prostate Imaging Reporting and Data System 3). Primary outcome was the detection of sPC (ISUP ≥ 2) in combined biopsy. Regression analysis was performed to identify predictors for this outcome. Descriptive statistics were applied to evaluate the hypothetical effect of involving PSAD into biopsy decision. Results: 273/1476 (18.5%) men were diagnosed with sPC by combined biopsy. MRI-targeted biopsy diagnosed less sPC as compared to combined strategy: 183/1476 (12.4%) vs. 273/1476 (18.5%), p<0.01. Regression analysis confirmed age (OR 1.10 [95% CI: 1.05 – 1.15]; p < 0.001), prior negative biopsy (OR 0.46 [0.24 – 0.89]; p = 0.022) and PSAD (p<0.001) as independent predictors for sPC. Applying a PSAD cut-off of 0.15 for biopsy decision, 817/1398 (58.4%) of the biopsy procedures would have been avoided at the cost of missing sPC in 91 (6.5%) men. Limitations were the retrospective design, heterogeneity of the study cohort due to the long inclusion period and a missing central revision of MRI. Conclusions: Age, previous biopsy status and PSAD were found independent predictors of sPC in men with equivocal prostate MRI. Implementation of PSAD into biopsy decision can avoid a large proportion of unnecessary biopsies. Clinical parameters such as PSAD need validation in a prospective setting.

Prediction of Significant Prostate Cancer in Equivocal Magnetic Resonance Imaging Lesions: A High-volume International Multicenter Study

BackgroundDecision of performing prostate biopsy in men with Prostate Imaging Reporting and Data System (PI-RADS) 3 findings in prostate magnetic resonance imaging (MRI) is challenging as they have a low but still relevant risk of harboring significant prostate cancer (sPC). ObjectiveTo identify clinical predictors of sPC in men with PI-RADS 3 lesions in prostate MRI and to analyze the hypothetical effect of incorporating prostate-specific antigen density (PSAD) into biopsy decision. Design, setting, and participantsWe analyzed a retrospective multinational cohort from ten academic centers comprising 1476 men who underwent a combined prostate biopsy (MRI targeted plus systematic biopsy) between February 2012 and April 2021 due to a PI-RADS 3 lesion in prostate MRI. Outcome measurements and statistical analysisThe primary outcome was the detection of sPC (ISUP ≥2) in a combined biopsy. Predictors were identified by a regression analysis. Descriptive statistics were applied to evaluate the hypothetical effect of involving PSAD into biopsy decision. Results and limitationsOf all patients, 273/1476 (18.5%) were diagnosed with sPC. MRI-targeted biopsy diagnosed fewer sPC cases than combined strategy: 183/1476 (12.4%) versus 273/1476 (18.5%), p < 0.01. Age (odds ratio [OR] 1.10 [95% confidence interval {CI}: 1.05–1.15], p < 0.001), prior negative biopsy (OR 0.46 [0.24–0.89], p = 0.022), and PSAD (p < 0.001) were found to be independent predictors of sPC. Applying a PSAD cutoff of 0.15, 817/1398 (58.4%) biopsies would have been avoided at the cost of missing sPC in 91 (6.5%) men. Limitations were the retrospective design, heterogeneity of the study cohort due to the long inclusion period, and no central revision of MRI. ConclusionsAge, previous biopsy status, and PSAD were found to be independent predictors of sPC in men with equivocal prostate MRI. Implementation of PSAD into biopsy decision can avoid unnecessary biopsies. Clinical parameters such as PSAD need validation in a prospective setting. Patient summaryIn this study, we looked for clinical predictors of significant prostate cancer in men with Prostate Imaging Reporting and Data System 3 lesions in prostate magnetic resonance imaging. We identified age, previous biopsy status, and especially prostate-specific antigen density as independent predictors.

Prediction of significant prostate cancer in equivocal MRI lesions: a high-volume international multicenter study

Prediction of significant prostate cancer in equivocal MRI lesions: a high-volume international multicenter study

Improved Prediction of Significant Prostate Cancer Following Repeated Prostate Biopsy by the Random Forest Classifier

Improved Prediction of Significant Prostate Cancer Following Repeated Prostate Biopsy by the Random Forest Classifier

A0624 - Role of PSA density in prediction of significant prostate cancer among Asian men with MRI-guided biopsies: A multicenter evaluation

A0624 - Role of PSA density in prediction of significant prostate cancer among Asian men with MRI-guided biopsies: A multicenter evaluation

Observational study comparing the accuracy/variability between the ERSPC and the PCPT risk calculators for the prediction of significant prostate cancer in patients with PSA

IntroductionRisk calculators (RCs) are easy-to-use tools considering available clinical variables that could help to select those patients with risk of prostate cancer (PCa) who should undergo a prostate biopsy.ObjectiveTo perform...

Prediction of significant prostate cancer in biopsy-naïve men: Validation of a novel risk model combining MRI and clinical parameters and comparison to an ERSPC risk calculator and PI-RADS.

BackgroundRisk models (RM) need external validation to assess their value beyond the setting in which they were developed. We validated a RM combining mpMRI and clinical parameters for the probability of harboring significant prostate cancer (sPC, Gleason Score ≥ 3+4) for biopsy-naïve men.Material and methodsThe original RM was based on data of 670 biopsy-naïve men from Heidelberg University Hospital who underwent mpMRI with PI-RADS scoring prior to MRI/TRUS-fusion biopsy 2012–2015. Validity was tested by a consecutive cohort of biopsy-naïve men from Heidelberg (n = 160) and externally by a cohort of 133 men from University College London Hospital (UCLH). Assessment of validity was performed at fusion-biopsy by calibration plots, receiver operating characteristics curve and decision curve analyses. The RM`s performance was compared to ERSPC-RC3, ERSPC-RC3+PI-RADSv1.0 and PI-RADSv1.0 alone.ResultsSPC was detected in 76 men (48%) at Heidelberg and 38 men (29%) at UCLH. The areas under the curve (AUC) were 0.86 for the RM in both cohorts. For ERSPC-RC3+PI-RADSv1.0 the AUC was 0.84 in Heidelberg and 0.82 at UCLH, for ERSPC-RC3 0.76 at Heidelberg and 0.77 at UCLH and for PI-RADSv1.0 0.79 in Heidelberg and 0.82 at UCLH. Calibration curves suggest that prevalence of sPC needs to be adjusted to local circumstances, as the RM overestimated the risk of harboring sPC in the UCLH cohort. After prevalence-adjustment with respect to the prevalence underlying ERSPC-RC3 to ensure a generalizable comparison, not only between the Heidelberg and die UCLH subgroup, the RM`s Net benefit was superior over the ERSPC`s and the mpMRI`s for threshold probabilities above 0.1 in both cohorts.ConclusionsThe RM discriminated well between men with and without sPC at initial MRI-targeted biopsy but overestimated the sPC-risk at UCLH. Taking prevalence into account, the model demonstrated benefit compared with clinical risk calculators and PI-RADSv1.0 in making the decision to biopsy men at suspicion of PC. However, prevalence differences must be taken into account when using or validating the presented risk model.

Prediction of significant prostate cancer in patients with previously negative prostate biopsy undergoing MRI/ultrasound-fusion biopsy in combination with systematic biopsy

Prediction of significant prostate cancer in patients with previously negative prostate biopsy undergoing MRI/ultrasound-fusion biopsy in combination with systematic biopsy

Editorial Comment

Due to the relatively modest survival benefit associated with the early detection of prostate cancer (PCa), prostate-specific antigen (PSA)-based screening has become controversial, with concerns regarding both overdiagnosis and overtreatment. 1 Kim E.H. Andriole G.L. Prostate-specific antigen-based screening: controversy and guidelines. BMC Med. 2015; 13: 61 Crossref PubMed Scopus (76) Google Scholar The authors of this manuscript attempt to consolidate the numerous disparate PSA screening recommendations into a unified guideline based on expert opinion informed by the best available data. 2 Vickers A.J. Eastham J.A. Scardino P.T. Lilja H. The Memorial Sloan Kettering Cancer Center recommendations for prostate cancer screening. Urology. 2016; https://doi.org/10.1016/j.urology.2015.12.054 Abstract Full Text Full Text PDF Scopus (49) Google Scholar The Memorial Sloan Kettering Cancer Center (MSKCC) recommendation for PCa screening begins at 45 years of age and provides a PSA-based risk-stratified algorithm: consider biopsy for those with PSA >3 ng/mL, routine screening for those with PSA between 1 and 3 ng/mL, and infrequent screening for those with PSA <1 ng/mL. Recommendations to begin testing at an earlier age and risk stratification according to PSA level were based in part on the Malmö Preventative Project study, 3 Lilja H. Cronin A.M. Dahlin A. et al. Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50. Cancer. 2011; 117: 1210-1219 Crossref PubMed Scopus (116) Google Scholar whereas the threshold to consider biopsy and the screening interval of 2 to 4 years were based on the results of the European Randomized Screening for Prostate Cancer and the United States prostate, lung, colorectal, and ovarian cancer screening trials. 4 Schroder F.H. Hugosson J. Roobol M.J. et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years follow-up. Lancet. 2014; 384: 6-12 Abstract Full Text Full Text PDF PubMed Scopus (1052) Google Scholar , 5 Andriole G.L. Crawford E.D. Grubb R.L. et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012; 104: 1-8 Crossref Scopus (826) Google Scholar

Prediction of Significant Prostate Cancer at Prostate Biopsy and Per Core Detection Rate of Targeted and Systematic Biopsies Using Real-Time Shear Wave Elastography

Introduction: Prostate cancer (PCa) detection is accompanied by overdiagnosis and mischaracterization of PCa. Therefore, new imaging modalities like shear wave elastography (SWE) are required. Aim: The aim of this study was to evaluate per-core detection rates (DRs) of targeted biopsies and systematic biopsies and to test if SWE findings can predict presence of clinically significant PCa (csPCa) at biopsy. Patients and Methods: Overall, 95 patients scheduled for prostate biopsy in our center underwent SWE. SWE findings were classified into suspicious or normal. Targeted biopsies were taken in up to 3 SWE-suspicious areas. csPCa was defined as the presence of Gleason pattern ≥4, level of prostate-specific antigen ≥10 ng/ml or >2 positive cores. Results: Overall DR for csPCa in our study cohort was 40%. Per-core DR for exclusively SWE-targeted cores versus systematic samples cores was 10.5 vs. 8.6% (p = 0.3). In the logistic regression models, individuals with suspicious SWE findings are at 6.4-fold higher risk of harboring csPCa (p = 0.03). Gain in predictive accuracy was 2.3% (0.82 vs. 0.84, p = 0.01). Conclusions: Presence of suspicious SWE findings is an independent predictor of csPCa. Therefore, SWE may be helpful in selecting patients for biopsy. Nonetheless, per-core DR for SWE-targeted cores was not statistically significant higher than DR of systematic sampled cores. Therefore, additional systematic biopsy is mandatory.

Prediction of Significant Prostate Cancer Diagnosed 20 to 30Years Later With a Single Measure of Prostate-Specific Antigen at or Before Age 50

Prediction of Significant Prostate Cancer Diagnosed 20 to 30Years Later With a Single Measure of Prostate-Specific Antigen at or Before Age 50

Prediction of Significant Prostate Cancer Diagnosed 20 to 30Years Later With a Single Measure of Prostate-Specific Antigen at or Before Age 50

Prediction of Significant Prostate Cancer Diagnosed 20 to 30Years Later With a Single Measure of Prostate-Specific Antigen at or Before Age 50

Editorial for “prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate‐specific antigen at or before age 50”

Prostate cancer screening with PSA as currently practiced is fraught with overdetection. Finding a new way to use PSA may allow us to focus our screening and diagnostic efforts on the men most in need.

Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate‐specific antigen at or before age 50

We previously reported that a single prostate-specific antigen (PSA) measured at ages 44-50 was highly predictive of subsequent prostate cancer diagnosis in an unscreened population. Here we report an additional 7 years of follow-up. This provides replication using an independent data set and allows estimates of the association between early PSA and subsequent advanced cancer (clinical stage ≥T3 or metastases at diagnosis). Blood was collected from 21,277 men in a Swedish city (74% participation rate) during 1974-1986 at ages 33-50. Through 2006, prostate cancer was diagnosed in 1408 participants; we measured PSA in archived plasma for 1312 of these cases (93%) and for 3728 controls. At a median follow-up of 23 years, baseline PSA was strongly associated with subsequent prostate cancer (area under the curve, 0.72; 95% CI, 0.70-0.74; for advanced cancer, 0.75; 95% CI, 0.72-0.78). Associations between PSA and prostate cancer were virtually identical for the initial and replication data sets, with 81% of advanced cases (95% CI, 77%-86%) found in men with PSA above the median (0.63 ng/mL at ages 44-50). A single PSA at or before age 50 predicts advanced prostate cancer diagnosed up to 30 years later. Use of early PSA to stratify risk would allow a large group of low-risk men to be screened less often but increase frequency of testing on a more limited number of high-risk men. This is likely to improve the ratio of benefit to harm for screening.