To assess the performance capabilities of multiparametric Magnetic Resonance Imaging (mpMRI), Prostate Health Index (PHI) and Prostate Cancer Antigen 3 gene (PCA3) in predicting the presence of pathologically confirmed significant Prostate Cancer (PCSPCa), according to the European Randomized Study of Screening Prostate Cancer (ERSPC) definition, in a same cohort of patients who underwent Radical Prostatectomy (RP) but eligible for Active Surveillance (AS).
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An observational retrospective study was performed in 120 prostate cancer (PCa) patients treated with robot-assisted RP but eligible for AS according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements, respectively. In addition, all patients underwent preoperatively and after 6-8 weeks from biopsy to mpMRI with a 1. 5T scanner using a 4-5 channel phase array coil combined with an endorectal coin. mpMRI images were assessed and diagrams depicting prostate sextants were used to designate regions of abnormalities within the prostate. Findings in the prostate were assigned to one of five categories according Prostate Imaging-Reporting and Data System guidelines (PI-RADS) and considered positive for PCa if final PI-RADS was >3 and negative if ≤3.
A pathologically confirmed reclassification was observed in 55 patients (45. 8%). mpMRI demonstrated a good specificity and negative predictive value (0. 61 and 0. 73, respectively) for ruling out a PCSPCa compared with PHI and PCA3. On multivariate analyses and after one thousand bootstrapping resampling, the inclusion of both PHI and mpMRI significantly increased the accuracy of the base model in predicting PCSPCa. Particularly, to predict PCSPCa, the base model had an AUC of 0. 71 which significantly increased by 4% with the addition of PHI (AUC=0. 75; p
In a same cohort of patients underwent to RP but eligible to AS, mpMRI and, to a lesser extent, PHI showed an important role in discriminating the presence of a PCSPCa. Consequently, they could be useful in both the selection and monitoring of patients undergoing AS. This article is protected by copyright. All rights reserved.
BJU international. 2015 Sep 09 [Epub ahead of print]
F Porpiglia, F Cantiello, S De Luca, M Manfredi, A Veltri, F Russo, A Sottile, R Damiano
Divisions of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Turin, Italy. , Urology Unit, Magna Graecia University of Catanzaro and Master in Laparoscopic and Robotic Surgery, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Turin, Italy. , Divisions of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Turin, Italy. , Divisions of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Turin, Italy. , Divisions of Radiology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Turin, Italy. , Division of Radiology, Candiolo Cancer Institute, Turin, Italy. , Laboratory Medicine, Candiolo Cancer Institute, Turin, Italy. , Urology Unit, Magna Graecia University of Catanzaro, Italy.