Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated?

Risk-based patient selection for systematic biopsy in prostate cancer diagnosis has been adopted in daily clinical practice, either by clinical judgment and PSA testing, or using multivariate risk prediction tools. The use of multivariable risk prediction tools can significantly reduce unnecessary systematic biopsies, without compromising the detection of clinically significant disease. Increasingly multi-parametric magnetic resonance imaging (MRI) is performed, not only in men with a persistent suspicion of prostate cancer after prior negative systematic biopsy, but also at initial screening before the first biopsy. The combination of MRI and multivariate risk prediction tools could potentially enhance prostate cancer diagnosis using multivariate MRI incorporated risk-based models to decide on the need for prostate MRI, but also using MRI results to adjusted risk-based models, and to guide MRI-directed biopsies. In this review, we discuss the diagnostic work-up for clinically significant prostate cancer, where the combination of MRI and multivariate risk prediction tools is integrated, and how together they can contribute to personalized diagnosis.

World journal of urology. 2019 Aug 09 [Epub ahead of print]

Ivo G Schoots, Anwar R Padhani

Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, P.O. Box 2040, 's-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands. ., Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK.