Assess radiologists' contribution to variation in clinically significant prostate cancer (csPCa) detection in patients with elevated prostate specific antigen (PSA) and mpMRI.
This Institutional Review Board-approved, retrospective cohort study was performed at a tertiary, academic, National Cancer Institute-designated Comprehensive Cancer Center with a multi-disciplinary prostate cancer program. Men undergoing mpMRI examinations 1/1/2015-12/31/2019 with elevated PSA (≥4 ng/mL) and biopsy within 6 months pre- or post-MRI and/or prostatectomy within 6 months post-mpMRI were included. Univariate and multivariable hierarchical logistic regression assessed impact of patient, provider, mpMRI examination, mpMRI report, and pathology factors on the diagnosis of Grade Group ≥2 csPCa.
Study cohort included 960 MRIs in 928 men, mean age 64.0 years (standard deviation±7.4). 59.8% (555/928) had csPCa. Interpreting radiologist was not significant individually (p=1.0) or combined with mpMRI ordering physician and physician performing biopsy/prostatectomy (p=0.41). PI-RADS 2 (Odds Ratio [OR] 0.18, p=0.04), PI-RADS 4 (OR 2.52, p<0.001), and PI-RADS 5 (OR 4.99, p<0.001) assessment compared to No Focal Lesion; PSA density of 0.1-0.15 ng/mL/cc (OR 2.46, p<0.001), 0.15-0.2 ng/mL/cc (OR 2.77, p<0.001), or ≥0.2 ng/mL/cc (OR 4.52, p<0.001); private insurance (reference=Medicare, OR 0.52, p=0.001), and unambiguous extra-prostatic extension on mpMRI (OR 2.94, p=0.01) were independently associated with csPCa. PI-RADS 3 assessment (OR 1.18, p=0.56), age (OR 0.99, p=0.39) and African American race (OR 0.90, p=0.75) were not.
Although there is known in-practice variation in radiologists' interpretation of multi-parametric prostate MRI (mpMRI), in our multi-disciplinary prostate cancer program we found no significant radiologist-attributable variation in csPCA detection.
Journal of the American College of Radiology : JACR. 2022 Oct 13 [Epub ahead of print]
Sachin Naik, Kristine S Burk, Elvira Budiawan, Ronilda Lacson, Leslie K Lee, Fiona M Fennessy, Clare Tempany, Alexander P Cole, Quoc-Dien Trinh, Adam S Kibel, Ramin Khorasani
Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, MA, USA; Departments of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, MA, USA; Departments of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: ., Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, MA, USA; Departments of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Departments of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Urological Surgery, Brigham and Women's Hospital, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
