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Combined clinical parameters and multiparametric MRI for advanced risk modeling of prostate cancer - patient-tailored risk stratification can reduce unnecessary biopsies

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Sources of Funding: None

Introduction

Multiparametric MRI (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC) detection (Gleason-score >= 3+4). Decision making based on European Randomised study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome PSA-screening limitations. We added pre-biopsy mpMRI to ERSPC-RC parameters and developed a risk model (RM) to predict individual sPC-risk on biopsy. _x000D_

Methods

We retrospectively analyzed clinical parameters of 755 men (biopsy-naive or after previous biopsy) who underwent mpMRI prior to MRI/TRUS-fusion-biopsy between 2012 and 2014 as training sample. The RM was validated in 404 consecutive patients in 2015. A stepwise multivariate regression analysis was used to determine significant sPC-predictors in the training set and to develop the RM. The accuracy was compared to ERSPC-RC3 (for biopsy-naive men) and 4 (for patients after previous biopsy) and PI-RADSv1.0 scoring using receiver operating characteristics (ROC). Discrimination and calibration of the RM, as well as net decision and reduction curve analyses were evaluated in validation set. _x000D_

Results

PSA, prostate volume, digital-rectal examination and PI-RADS were significant sPC-predictors and included in the RM (Figure a). ROC area under the curve (AUC) for the RM was significantly larger (0.82 each), compared to ERSPC-RC3 (0.79, p=0.004), RC4 (0.68, p<0.001) and PI-RADS (0.74-76, p=0.015 and p=0.006)(Figure b-e). Similarly, in the validation cohort, RM`s discrimination was higher for biopsy-naive and post-biopsy men (0.84 and 0.76), compared to PI-RADS (0.76 and 0.69, p=0.002 and p=0.006) and ERSPC-RC3/4 (0.79/0.74, p=0.003/p=0.146). The calibration plot demonstrated an excellent slope (1.03)(Figure f). The RM`s benefit exceeded that of ERSPC-RCs and PI-RADS in the decision which patient to biopsy and enabled the highest reduction rate of unnecessary biopsies. _x000D_

Conclusions

The novel RM, incorporating ERSPC-RC parameters and PI-RADS, performed significantly better compared to the tools alone and provides measurable benefit in making the decision to biopsy men at suspicion of PC. _x000D_

Funding

None

Authors
Jan Philipp Radtke
Bonekamp David
Claudia Kesch
Martin Freitag
Bertram Hitthaler
Matthias Claudius Roethke
Celine Alt
Kathrin Wieczorek
Wilfried Roth
Stefan Duensing
Dogu Teber
Heinz-Peter Schlemmer
Markus Hohenfellner
Boris Hadaschik
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