Variability of mpMRI diagnostic performance according to the upfront individual patient risk of having clinically significant prostate cancer.
Prostate
; 84(5): 473-478, 2024 Apr.
Article
em En
| MEDLINE
| ID: mdl-38149793
ABSTRACT
BACKGROUND:
To assess the variation of multiparametric magnetic resonance imaging (mpMRI) positive predictive value (PPV) according to each patient's risk of clinically significant prostate cancer (csPCa) based exclusively on clinical factors.METHODS:
We evaluated 999 patients with positive mpMRI (PI-RADS ≥ 3) receiving targeted (TBx) plus systematic prostate biopsy. We built a multivariable logistic regression analysis (MVA) using clinical risk factors to calculate the individual patients' risk of harboring csPCa at TBx. A second MVA tested the association between individual patients' clinical risk and mpMRI PPV accounting for the PI-RADS score. Finally, we plotted the PPV of each PI-RADS score by the individual patient pretest probability of csPCa using a LOWESS approach.RESULTS:
Overall, TBx found csPCa in 21%, 51%, and 80% of patients with PI-RADS 3, 4, and 5 lesions, respectively. At MVA, age, PSA, digital rectal examination (DRE), and prostate volume were significantly associated with the risk of csPCa at biopsy. DRE yielded the highest odds ratio (OR 2.88; p < 0.001). The individual patient's clinical risk was significantly associated with mpMRI PPV (OR 2.49; p < 0.001) using MVA. Plotting the mpMRI PPV according to the predicted clinical risks, we observed that for patients with clinical risk close to 0 versus patients with risk higher than 90%, the mpMRI PPV of PI-RADS 3, 4, and 5 ranged from 0% to 75%, from 0% to 96%, and from 45% to 100%, respectively.CONCLUSION:
mpMRI PPV varies according to the individual pretest patient's risk based on clinical factors. These findings should be considered in the decision-making process for patients with suspect MRI findings referred for a prostate biopsy. Moreover, our data support the need for further studies to create an individualized risk prediction tool.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Próstata
/
Imageamento por Ressonância Magnética Multiparamétrica
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Itália