To evaluate the complementary value of urinary MyProstateScore (MPS) testing and multiparametric MRI (mpMRI) and assess outcomes in patients with equivocal mpMRI.
Included patients underwent mpMRI followed by urine collection and prostate biopsy at the University of Michigan between 2015-2019. MPS values were calculated from urine specimens using the validated model based on serum PSA, urinary PCA3, and urinary TMPRSS2:ERG. In the PI-RADS 3 population, the discriminative accuracy of PSA, PSAD, and MPS for GG≥2 cancer was quantified by the AUC curve. Decision curve analysis was used to assess net benefit of MPS relative to PSAD.
There were 540 patients that underwent mpMRI and biopsy with MPS available. The prevalence of GG≥2 cancer was 13% for PI-RADS 3, 56% for PI-RADS 4, and 87% for PI-RADS 5. MPS was significantly higher in men with GG≥2 cancer [median 44.9, IQR (29.4-57.5)] than those with negative or GG1 biopsy [median 29.2, IQR (14.8-44.2); p<0.001] in the overall population and when stratified by PI-RADS score. In the PI-RADS 3 population (n=121), the AUC for predicting GG≥2 cancer was 0.55 for PSA, 0.62 for PSAD, and 0.73 for MPS. MPS provided the highest net clinical benefit across all pertinent threshold probabilities.
In patients that underwent mpMRI and biopsy, MPS was significantly associated with GG≥2 cancer across all PI-RADS scores. In the PI-RADS 3 population, MPS significantly outperformed PSAD in ruling out GG≥2 cancer. These findings suggest a complementary role of MPS testing in patients that have undergone mpMRI.
Urology. 2021 Dec 11 [Epub ahead of print]
Jeffrey J Tosoian, Udit Singhal, Matthew S Davenport, John T Wei, Jeffrey S Montgomery, Arvin K George, Simpa S Salami, Stanley G Mukundi, Javed Siddiqui, Lakshmi P Kunju, Benjamin P Tooke, C Yoonhee Ryder, Sarah P Dugan, Zoey Chopra, Rachel Botbyl, Yilin Feng, Michael S Sessine, Nicholas W Eyrich, Ashley E Ross, Bruce J Trock, Scott A Tomlins, Ganesh S Palapattu, Arul M Chinnaiyan, Yashar S Niknafs, Todd M Morgan
Department of Urology, Vanderbilt University, Nashville, Tennessee 37235; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee 37235; Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan 48109. Electronic address: ., Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109; Department of Urology, Mayo Clinic, Rochester, Minnesota 55901., Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109., Department of Urology, University of Michigan, Ann Arbor, Michigan 48109., Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109., Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan 48109., Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109., University of Michigan Medical School, Ann Arbor, Michigan 48109., Department of Urology, Wayne State University, Detroit, Michigan 48202., Department of Urology, Emory University, Atlanta, Georgia 30322., Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois 60611., Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287., Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan 48109; Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109., Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109; Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, University of Michigan, Ann Arbor, Michigan 48109; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan 48109; Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109; Howard Hughes Medical Institute, University of Michigan, Ann Arbor, Michigan 48109.