Radiologists' contribution to variation in detecting clinically significant prostate cancer in men with prostate MRI.

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.

email news signup