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Added value of systematic biopsy in men with a clinical suspicion of prostate cancer undergoing biparametric MRI-targeted biopsy: multi-institutional external validation study.

Authors
  • Falagario, Ugo1, 2
  • Jambor, Ivan3, 4, 5
  • Taimen, Pekka6
  • Syvänen, Kari T7
  • Kähkönen, Esa7
  • Merisaari, Harri3, 8
  • Montoya Perez, Ileana3, 8
  • Knaapila, Juha7
  • Steiner, Aida3, 5
  • Verho, Janne3, 5
  • Tewari, Ashutosh9
  • Aronen, Hannu J3, 5
  • Carrieri, Giuseppe10
  • Boström, Peter J7
  • Ettala, Otto7
  • 1 Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy. [email protected] , (Italy)
  • 2 Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA. [email protected]
  • 3 Department of Radiology, University of Turku, Turku, Finland. , (Finland)
  • 4 Department of Radiology, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
  • 5 Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland. , (Finland)
  • 6 Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland. , (Finland)
  • 7 Department of Urology, University of Turku and Turku University Hospital, Turku, Finland. , (Finland)
  • 8 Department of Future Technologies, University of Turku, Turku, Finland. , (Finland)
  • 9 Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
  • 10 Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy. , (Italy)
Type
Published Article
Journal
World journal of urology
Publication Date
Aug 10, 2020
Identifiers
DOI: 10.1007/s00345-020-03393-8
PMID: 32778912
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We aimed to develop and externally validate a nomogram based on MRI volumetric parameters and clinical information for deciding when SBx should be performed in addition to TBx in man with suspicious prostate MRI. Retrospective analyses of single (IMPROD, NCT01864135) and multi-institution (MULTI-IMPROD, NCT02241122) clinical trials. All men underwent a unique rapid biparametric magnetic resonance imaging (IMPROD bpMRI) consisting of T2-weighted imaging and three separate DWI acquisitions. Men with IMPROD bpMRI Likert scores of 3-5 were included. Logistic regression models were developed using IMPROD trial (n = 122) and validated using MULTI-IMPROD trial (n = 262) data. The model's performance was evaluated in the terms of PCa detection with Gleason Grade Group 1 (clinically insignificant prostate cancer, iPCa) and > 1 (clinically significant prostate cancer, csPCa). Net benefits and decision curve analyses (DCA) were compared. Combined biopsies were used for reference. The developed nomogram included age, PSA, prostate volume, MRI suspicion score (IMPROD bpMRI Likert or PIRADsv2.1 score), MRI-suspicion lesion volume percentage, and lesion location. All these variables were significant predictors of csPCa in SBx in multivariable analysis. In the validation cohort (n = 262) using different nomogram cutoffs, 19-43% of men would have avoided SBx while missing 1-4% of csPCa and avoiding detection of 9-20% of iPCa. Similar performance was found for nomograms using IMPROD bpMRI Likert score or v2.1. The developed nomogram demonstrated potential to select men with a clinical suspicion of PCa who would benefit from performing SBx in addition to TBx. Public access to the nomogram is provided at: https://petiv.utu.fi/multiimprod/ .

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