Christopher S Lim1, Jorge Abreu-Gomez1,2, Michel-Alexandre Leblond1, Ivan Carrion1, Danny Vesprini3, Nicola Schieda4, Laurence Klotz5. 1. Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 2. Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada. 3. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 4. Department of Radiology, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada. 5. Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Abstract
INTRODUCTION: We aimed to determine if clinical and imaging features can stratify men at higher risk for clinically significant (CS, International Society of Urological Pathology [ISUP] grade group ≥2) prostate cancer (PCa) in equivocal Prostate Imaging and Data Reporting System (PI-RADS) category 3 lesions on magnetic resonance imaging (MRI). METHODS: Approved by the institutional review board, this retrospective study involved 184 men with 198 lesions who underwent 3T-MRI and MRI-directed transrectal ultrasound biopsy for PI-RADS 3 lesions. Men were evaluated including clinical stage, prostate-specific antigen density (PSAD), indication, and MRI lesion size. Diagnoses for all men and by indication (no cancer, any PCa, CSPCa) were compared using multivariate logistic regression, including stage, PSAD, and lesion size. RESULTS: We found an overall PCa rate of 31.8% (63/198) and 10.1% (20/198) CSPCa (13 grade group 2, five group 3, and two group 4). Higher stage (p=0.001), PSAD (p=0.007), and lesion size (p=0.015) were associated with CSPCa, with no association between CSPCa and age, PSA, or prostate volume (p>0.05). PSAD modestly predicted CSPCa area under the curve (AUC) 0.66 (95% confidence interval [CI] 0.518-0.794) in all men and 0.64 (0.487-0.799) for those on active surveillance (AS). Model combining clinical stage, PSAD, and lesion size improved accuracy for all men and AS (AUC 0.82 [0.736-0.910], p<0.001 and 0.785 [0.666-0.904], p<0.001). In men with prior negative biopsy and persistent suspicion, PSAD (0.90 [0.767-1.000]) was not different from the model (p>0.05), with optimal cutpoint of ≥0.215 ng/mL/cc achieving sensitivity/specificity of 85.7/84.4%. CONCLUSIONS: PI-RADSv2 category 3 lesions are often not CSPCa. PSAD predicted CSPCa in men with a prior negative biopsy; however, PSAD alone had limited value, and accuracy improved when using a model incorporating PSAD with clinical stage and MRI lesion size.
INTRODUCTION: We aimed to determine if clinical and imaging features can stratify men at higher risk for clinically significant (CS, International Society of Urological Pathology [ISUP] grade group ≥2) prostate cancer (PCa) in equivocal Prostate Imaging and Data Reporting System (PI-RADS) category 3 lesions on magnetic resonance imaging (MRI). METHODS: Approved by the institutional review board, this retrospective study involved 184 men with 198 lesions who underwent 3T-MRI and MRI-directed transrectal ultrasound biopsy for PI-RADS 3 lesions. Men were evaluated including clinical stage, prostate-specific antigen density (PSAD), indication, and MRI lesion size. Diagnoses for all men and by indication (no cancer, any PCa, CSPCa) were compared using multivariate logistic regression, including stage, PSAD, and lesion size. RESULTS: We found an overall PCa rate of 31.8% (63/198) and 10.1% (20/198) CSPCa (13 grade group 2, five group 3, and two group 4). Higher stage (p=0.001), PSAD (p=0.007), and lesion size (p=0.015) were associated with CSPCa, with no association between CSPCa and age, PSA, or prostate volume (p>0.05). PSAD modestly predicted CSPCa area under the curve (AUC) 0.66 (95% confidence interval [CI] 0.518-0.794) in all men and 0.64 (0.487-0.799) for those on active surveillance (AS). Model combining clinical stage, PSAD, and lesion size improved accuracy for all men and AS (AUC 0.82 [0.736-0.910], p<0.001 and 0.785 [0.666-0.904], p<0.001). In men with prior negative biopsy and persistent suspicion, PSAD (0.90 [0.767-1.000]) was not different from the model (p>0.05), with optimal cutpoint of ≥0.215 ng/mL/cc achieving sensitivity/specificity of 85.7/84.4%. CONCLUSIONS: PI-RADSv2 category 3 lesions are often not CSPCa. PSAD predicted CSPCa in men with a prior negative biopsy; however, PSAD alone had limited value, and accuracy improved when using a model incorporating PSAD with clinical stage and MRI lesion size.
Authors: Alexander P Kenigsberg; Audrey Renson; Andrew B Rosenkrantz; Richard Huang; James S Wysock; Samir S Taneja; Marc A Bjurlin Journal: Eur Urol Oncol Date: 2018-10-05
Authors: Tim Ullrich; Michael Quentin; Christian Arsov; Anna Katharina Schmaltz; Alexander Tschischka; Nina Laqua; Andreas Hiester; Dirk Blondin; Robert Rabenalt; Peter Albers; Gerald Antoch; Lars Schimmöller Journal: J Urol Date: 2017-09-20 Impact factor: 7.450
Authors: Marloes van der Leest; Erik Cornel; Bas Israël; Rianne Hendriks; Anwar R Padhani; Martijn Hoogenboom; Patrik Zamecnik; Dirk Bakker; Anglita Yanti Setiasti; Jeroen Veltman; Huib van den Hout; Hans van der Lelij; Inge van Oort; Sjoerd Klaver; Frans Debruyne; Michiel Sedelaar; Gerjon Hannink; Maroeska Rovers; Christina Hulsbergen-van de Kaa; Jelle O Barentsz Journal: Eur Urol Date: 2018-11-23 Impact factor: 20.096
Authors: James L Mohler; Emmanuel S Antonarakis; Andrew J Armstrong; Anthony V D'Amico; Brian J Davis; Tanya Dorff; James A Eastham; Charles A Enke; Thomas A Farrington; Celestia S Higano; Eric Mark Horwitz; Michael Hurwitz; Joseph E Ippolito; Christopher J Kane; Michael R Kuettel; Joshua M Lang; Jesse McKenney; George Netto; David F Penson; Elizabeth R Plimack; Julio M Pow-Sang; Thomas J Pugh; Sylvia Richey; Mack Roach; Stan Rosenfeld; Edward Schaeffer; Ahmad Shabsigh; Eric J Small; Daniel E Spratt; Sandy Srinivas; Jonathan Tward; Dorothy A Shead; Deborah A Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2019-05-01 Impact factor: 11.908
Authors: Christian B van der Pol; Stefanie Lee; Scott Tsai; Natasha Larocque; Abdullah Alayed; Phillip Williams; Nicola Schieda Journal: Abdom Radiol (NY) Date: 2019-03
Authors: Jelle O Barentsz; Jeffrey C Weinreb; Sadhna Verma; Harriet C Thoeny; Clare M Tempany; Faina Shtern; Anwar R Padhani; Daniel Margolis; Katarzyna J Macura; Masoom A Haider; Francois Cornud; Peter L Choyke Journal: Eur Urol Date: 2015-09-08 Impact factor: 20.096
Authors: Magdalena Görtz; Jan Philipp Radtke; Gencay Hatiboglu; Viktoria Schütz; Georgi Tosev; Maximilian Güttlein; Jonas Leichsenring; Albrecht Stenzinger; David Bonekamp; Heinz-Peter Schlemmer; Markus Hohenfellner; Joanne Nyaboe Nyarangi-Dix Journal: Eur Urol Focus Date: 2019-12-12