The Mount Sinai Prebiopsy Risk Calculator for Predicting any Prostate Cancer and Clinically Significant Prostate Cancer: Development of a Risk Predictive Tool and Validation with Advanced Neural Networking, Prostate Magnetic Resonance Imaging Outcome Data

The European Association of Urology guidelines recommend the use of imaging, biomarkers, and risk calculators in men at risk of prostate cancer. Risk predictive calculators that combine multiparametric magnetic resonance imaging with prebiopsy variables aid as an individualized decision-making tool for patients at risk of prostate cancer, and advanced neural networking increases reliability of these tools.

To develop a comprehensive risk predictive online web-based tool using magnetic resonance imaging (MRI) and clinical data, to predict the risk of any prostate cancer (PCa) and clinically significant PCa (csPCa) applicable to biopsy-naïve men, men with a prior negative biopsy, men with prior positive low-grade cancer, and men with negative MRI.

Institutional review board-approved prospective data of 1902 men undergoing biopsy from October 2013 to September 2021 at Mount Sinai were collected.

Univariable and multivariable analyses were used to evaluate clinical variables such as age, race, digital rectal examination, family history, prostate-specific antigen (PSA), biopsy status, Prostate Imaging Reporting and Data System score, and prostate volume, which emerged as predictors for any PCa and csPCa. Binary logistic regression was performed to study the probability. Validation was performed with advanced neural networking (ANN), multi-institutional European cohort (Prostate MRI Outcome Database [PROMOD]), and European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSPC RC) 3/4.

Overall, 2363 biopsies had complete clinical information, with 57.98% any cancer and 31.40% csPCa. The prediction model was significantly associated with both any PCa and csPCa having an area under the curve (AUC) of 81.9% including clinical data. The AUC for external validation was calculated in PROMOD, ERSPC RC, and ANN for any PCa (0.82 vs 0.70 vs 0.90) and csPCa (0.82 vs 0.78 vs 0.92), respectively. This study is limited by its retrospective design and overestimation of csPCa in the PROMOD cohort.

The Mount Sinai Prebiopsy Risk Calculator combines PSA, imaging and clinical data to predict the risk of any PCa and csPCa for all patient settings. With accurate validation results in a large European cohort, ERSPC RC, and ANN, it exhibits its efficiency and applicability in a more generalized population. This calculator is available online in the form of a free web-based tool that can aid clinicians in better patients counseling and treatment decision-making.

We developed the Mount Sinai Prebiopsy Risk Calculator (MSP-RC) to assess the likelihood of any prostate cancer and clinically significant disease based on a combination of clinical and imaging characteristics. MSP-RC is applicable to all patient settings and accessible online.

European urology open science. 2022 May 20*** epublish ***

Sneha Parekh, Parita Ratnani, Ugo Falagario, Dara Lundon, Deepshikha Kewlani, Jordan Nasri, Zach Dovey, Dimitrios Stroumbakis, Daniel Ranti, Ralph Grauer, Stanislaw Sobotka, Adriana Pedraza, Vinayak Wagaskar, Lajja Mistry, Ivan Jambor, Anna Lantz, Otto Ettala, Armando Stabile, Pekka Taimen, Hannu J Aronen, Juha Knaapila, Ileana Montoya Perez, Giorgio Gandaglia, Alberto Martini, Wolfgang Picker, Erik Haug, Luigi Cormio, Tobias Nordström, Alberto Briganti, Peter J Boström, Giuseppe Carrieri, Kenneth Haines, Michael A Gorin, Peter Wiklund, Mani Menon, Ash Tewari

Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, University of Turku and Turku University hospital, Turku, Finland., Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Institute of Biomedicine, University of Turku, Turku, Finland., Department of Radiology, University of Turku, Turku, Finland., Department of Radiology, Aleris Cancer Center, Oslo, Norway., Section of Urology, Vestfold Hospital Trust, Tønsberg, Norway., Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy., Urology Associates and UPMC Western Maryland, Cumberland, MD, USA.

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