ORLANDO, FL USA (UroToday.com) - The PCPT risk calculator has been proposed as a means to improve upon the limitations of PSA in selecting men for prostate biopsy. The authors of this study sought to compare the performance of the PCPT risk calculator with multiparametic MRI (MP-MRI) in classifying men at risk for prostate cancer. Men with an abnormal PSA or DRE, as well as a suspicious lesions identified on MP-MRI, were prospectively enrolled. Three radiologists reviewed the images and graded the lesions on a 5-point Likert scale. An MR/TRUS fusion guided biopsy, as well as a standard 12-core systematic biopsy, was then performed and pathology reviewed by a single pathologist.
The authors determined the AUC for the PCPT risk calculator predicted risk of any prostate cancer was 0.67. The sensitivity, specificity, and false positive rate of the PCPT risk calculator with a cutoff of 30% as proposed by Nam et al (JCO, 2011) were 98.9%, 0% and 34.8%, respectively. The AUC for predicted risk of aggressive disease was 0.68. This was compared to the AUC of MP-MRI for predicting any prostate cancer and aggressive disease, as 0.76 and 0.84, respectively.
MP-MRI seemed to significantly outperform the PCPT risk calculator in selecting men for prostate biopsy. The authors point out that the MP-MRI also provides staging information and risk stratification that can be used to guide treatment. Despite the findings in an optimized patient cohort, the study reveals than the integration of MP-MRI into a patient risk assessment can be yet another adjunct to treatment planning based on recent advances in preoperative imaging.
Presented by Simpa Salami at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
New Hyde Park, NY USA
Written by Jason T. Rothwax, National Cancer Institute