A Model for Predicting Clinically Significant Prostate Cancer Using Prostate MRI and Risk Factors.
J Am Coll Radiol
; 21(9): 1419-1427, 2024 Sep.
Article
en En
| MEDLINE
| ID: mdl-38719106
ABSTRACT
PURPOSE:
The aim of this study was to develop and validate a predictive model for clinically significant prostate cancer (csPCa) using prostate MRI and patient risk factors.METHODS:
In total, 960 men who underwent MRI from 2015 to 2019 and biopsy either 6 months before or 6 months after MRI were identified. Men diagnosed with csPCa were identified, and csPCa risk was modeled using known patient factors (age, race, and prostate-specific antigen [PSA] level) and prostate MRI findings (location, Prostate Imaging Reporting and Data System score, extraprostatic extension, dominant lesion size, and PSA density). csPCa was defined as Gleason score sum ≥ 7. Using a derivation cohort, a multivariable logistic regression model and a point-based scoring system were developed to predict csPCa. Discrimination and calibration were assessed in a separate independent validation cohort.RESULTS:
Among 960 MRI reports, 552 (57.5%) were from men diagnosed with csPCa. Using the derivation cohort (n = 632), variables that predicted csPCa were Prostate Imaging Reporting and Data System scores of 4 and 5, the presence of extraprostatic extension, and elevated PSA density. Evaluation using the validation cohort (n = 328) resulted in an area under the curve of 0.77, with adequate calibration (Hosmer-Lemeshow P = .58). At a risk threshold of >2 points, the model identified csPCa with sensitivity of 98.4% and negative predictive value of 78.6% but prevented only 4.3% potential biopsies (0-2 points; 14 of 328). At a higher threshold of >5 points, the model identified csPCa with sensitivity of 89.5% and negative predictive value of 70.1% and avoided 20.4% of biopsies (0-5 points; 67 of 328).CONCLUSIONS:
The point-based model reported here can potentially identify a vast majority of men at risk for csPCa, while avoiding biopsy in about 1 in 5 men with elevated PSA levels.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias de la Próstata
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Imagen por Resonancia Magnética
Límite:
Aged
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Am Coll Radiol
/
J. Am. Coll. Radiol
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Journal of the American College of Radiology
Asunto de la revista:
RADIOLOGIA
Año:
2024
Tipo del documento:
Article
Pais de publicación:
Estados Unidos