Multi‐institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI‐RADS 3 lesions. Issue 18 (12th July 2022)

• Record Type: Journal Article
• Authors: Fang, Andrew M.; Shumaker, Luke A.; Martin, Kimberly D.; Jackson, Jamaal C.; Fan, Richard E.; Khajir, Ghazal; Patel, Hiten D.; Soodana‐Prakash, Nachiketh; Vourganti, Srinivas; Filson, Christopher P.; Sonn, Geoffrey A.; Sprenkle, Preston C.; Gupta, Gopal N.; Punnen, Sanoj; Rais‐Bahrami, Soroush
• Is Part Of: Cancer. Volume 128:Issue 18(2022)
• Page Start: 3287
• Page End: 3296
• Publication Date: 2022-07-12
• Subjects: active surveillance -- cancer screening -- multiparametric magnetic resonance imaging -- prostatic adenocarcinoma -- risk calculator; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.34355
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: Most Prostate Imaging–Reporting and Data System (PI‐RADS) 3 lesions do not contain clinically significant prostate cancer (CSPCa; grade group ≥2). This study was aimed at identifying clinical and magnetic resonance imaging (MRI)–derived risk fac‐ tors that predict CSPCa in men with PI‐RADS 3 lesions. Methods: This study analyzed the detection of CSPCa in men who underwent MRI‐targeted biopsy for PI‐RADS 3 lesions. Multivariable logistic regression models with goodness‐of‐fit testing were used to identify variables associated with CSPCa. Receiver operating curves and decision curve analyses were used to estimate the clinical utility of a predictive model. Results: Of the 1784 men reviewed, 1537 were included in the training cohort, and 247 were included in the validation cohort. The 309 men with CSPCa (17.3%) were older, had a higher prostate‐specific antigen (PSA) density, and had a greater likelihood of an anteriorly located lesion than men without CSPCa ( p < .01). Multivariable analysis revealed that PSA density (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.05–1.85; p < .01), age (OR, 1.05; 95% CI, 1.02–1.07; p < .01), and a biopsy‐naive status (OR, 1.83; 95% CI, 1.38–2.44) were independently associated with CSPCa. A prior negative biopsy was negatively associated (OR, 0.35; 95% CI, 0.24–0.50; p < .01). The application of the model to the validation cohort resulted in an area under the curve of 0.78. A predicted risk threshold of 12% could have prevented 25% of biopsies while detecting almost 95% of CSPCas with a sensitivity of 94% and a specificity of 34%. Conclusions: For PI‐RADS 3 lesions, an elevated PSA density, older age, and a biopsy‐naive status were associated with CSPCa, whereas a prior negative biopsy was negatively associated. A predictive model could prevent PI‐RADS 3 biopsies while missing few CSPCas. Lay summary: Among men with an equivocal lesion (Prostate Imaging–Reporting and Data System 3) on multiparametric magnetic resonance imaging (mpMRI), those who are older, those who have a higher prostate‐specific antigen density, and those who have never had a biopsy before are at higher risk for having clinically significant prostate cancer (CSPCa) on subsequent biopsy. However, men with at least one negative biopsy have a lower risk of CSPCa. A new predictive model can greatly reduce the need to biopsy equivocal lesions noted on mpMRI while missing only a few cases of CSPCa. Abstract : In men with a Prostate Imaging–Reporting and Data System (PI‐RADS) 3 index lesion, an elevated prostate‐specific antigen density, older age, an anteriorly located lesion, and a biopsy‐naive status were associated with the detection of clinically significant prostate cancer on subsequent biopsy, whereas a history of a prior negative biopsy was negatively associated. A novel predictive model could prevent PI‐RADS 3 biopsies while missing few cases of clinically significant prostate cancer.