Lingyun Zhai1,2,3,4, Yu Fan1,2,5,3,4, Yisen Meng1,2,3,4, Xueru Feng6, Wei Yu7,8,9,10, Jie Jin11,12,13,14. 1. Department of Urology, Peking University First Hospital, Beijing, China. 2. Institute of Urology, Peking University First Hospital, Beijing, China. 3. National Urological Cancer Center, Beijing, China. 4. Beijing Key Laboratory of Urogential diseases(male) molecular diagnosis and treatment center, Beijing, China. 5. Department of Urology, Tibet Autonomous Region People's Hospital, Lhasa, Tibet, China. 6. Department of Geriatrics, Peking University First Hospital, Beijing, China. 7. Department of Urology, Peking University First Hospital, Beijing, China. yuweif@126.com. 8. Institute of Urology, Peking University First Hospital, Beijing, China. yuweif@126.com. 9. National Urological Cancer Center, Beijing, China. yuweif@126.com. 10. Beijing Key Laboratory of Urogential diseases(male) molecular diagnosis and treatment center, Beijing, China. yuweif@126.com. 11. Department of Urology, Peking University First Hospital, Beijing, China. jinjie@vip.163.com. 12. Institute of Urology, Peking University First Hospital, Beijing, China. jinjie@vip.163.com. 13. National Urological Cancer Center, Beijing, China. jinjie@vip.163.com. 14. Beijing Key Laboratory of Urogential diseases(male) molecular diagnosis and treatment center, Beijing, China. jinjie@vip.163.com.
Abstract
BACKGROUND: The contemporary active surveillance (AS) criteria may result in an unsatisfactory misclassification rate, which may delay curative treatment for prostate cancer patients. The magnetic resonance imaging (MRI), not included in any AS criteria, provides useful information for prostate cancer diagnosis. Our goal is to evaluate the diagnostic performance of Prostate Imaging Reporting and Data Systems (PI-RADS) score, a standardized MRI reporting system, in AS candidates enrollment. METHODS: We searched Cochrane CENTRAL, PubMed, and Embase for pertinent studies through June 2018. The standard methods recommended for meta-analyses of diagnostic evaluation were employed. We draw the summary receiver operating characteristic (SROC) curve. Meta-regression analysis was performed to evaluate the effects of confounding factors. RESULTS: From the resulting 168 studies, 5 provided the diagnostic data on PI-RADS score and pathological results; 834 patients were included. All AS candidates in these studies were defined by Prostate Cancer Research International: Active Surveillance (PRIAS) criterion. The pooled estimates of PI-RADS 4 or 5 on adverse pathological features at radical prostatectomy (RP) among AS candidates were: sensitivity, 0.77 (95% confidence interval (CI), 0.71-0.82); specificity, 0.63 (95% CI, 0.55-0.71); positive predictive value, 0.72 (95% CI, 0.64-0.79); negative predictive value, 0.68 (95% CI, 0.63-0.73); and diagnostic odds ratio, 6 (95% CI, 4-8). The SROC curve was positioned toward the desired upper left corner of the curve, the area under the curve was 0.77 (95% CI, 0.73-0.80). The P-value for heterogeneity was <0.01. The pathological outcomes and endorectal coils contributed to the heterogeneity of sensitivity. The evidences supporting the advantage of PI-RADS v2 over v1 were not sufficient yet. CONCLUSION: AS candidates with PI-RADS 4 or 5 may be unsuitable for AS even though they fulfill current AS criteria. Those with PI-RADS 3 or less indicated relative safety for AS enrollment.
BACKGROUND: The contemporary active surveillance (AS) criteria may result in an unsatisfactory misclassification rate, which may delay curative treatment for prostate cancerpatients. The magnetic resonance imaging (MRI), not included in any AS criteria, provides useful information for prostate cancer diagnosis. Our goal is to evaluate the diagnostic performance of Prostate Imaging Reporting and Data Systems (PI-RADS) score, a standardized MRI reporting system, in AS candidates enrollment. METHODS: We searched Cochrane CENTRAL, PubMed, and Embase for pertinent studies through June 2018. The standard methods recommended for meta-analyses of diagnostic evaluation were employed. We draw the summary receiver operating characteristic (SROC) curve. Meta-regression analysis was performed to evaluate the effects of confounding factors. RESULTS: From the resulting 168 studies, 5 provided the diagnostic data on PI-RADS score and pathological results; 834 patients were included. All AS candidates in these studies were defined by Prostate Cancer Research International: Active Surveillance (PRIAS) criterion. The pooled estimates of PI-RADS 4 or 5 on adverse pathological features at radical prostatectomy (RP) among AS candidates were: sensitivity, 0.77 (95% confidence interval (CI), 0.71-0.82); specificity, 0.63 (95% CI, 0.55-0.71); positive predictive value, 0.72 (95% CI, 0.64-0.79); negative predictive value, 0.68 (95% CI, 0.63-0.73); and diagnostic odds ratio, 6 (95% CI, 4-8). The SROC curve was positioned toward the desired upper left corner of the curve, the area under the curve was 0.77 (95% CI, 0.73-0.80). The P-value for heterogeneity was <0.01. The pathological outcomes and endorectal coils contributed to the heterogeneity of sensitivity. The evidences supporting the advantage of PI-RADS v2 over v1 were not sufficient yet. CONCLUSION: AS candidates with PI-RADS 4 or 5 may be unsuitable for AS even though they fulfill current AS criteria. Those with PI-RADS 3 or less indicated relative safety for AS enrollment.
Authors: Vasilis Stavrinides; Francesco Giganti; Bruce Trock; Shonit Punwani; Clare Allen; Alex Kirkham; Alex Freeman; Aiman Haider; Rhys Ball; Neil McCartan; Hayley Whitaker; Clement Orczyk; Mark Emberton; Caroline M Moore Journal: Eur Urol Date: 2020-04-30 Impact factor: 20.096