To validate the use of biparametric (T2- and diffusion weighted) magnetic resonance imaging (B-MRI) and prostate-specific antigen (PSA)/PSA density (PSAD) in a biopsy naïve cohort at risk for prostate cancer (PCa).
All patients (n=59) underwent PSA screening and digital rectal exam (DRE) prior to a B-MRI followed by MRI/transrectal ultrasound (TRUS) fusion-guided targeted biopsy. Previously reported composite formulas incorporating screen positive lesions (SPL) on B-MRI and PSA or PSAD were developed to maximize PCa detection. For PSA, a patient was considered screen positive if PSA level + 6 x (the number of SPL) >14. For PSAD, screening was positive if PSAD x 14 + (the number of SPL) >4. 25. These were employed in this new test set to validate the initial formulae. Performance assessment of these formulas was determined for all cancer detection and for tumors with Gleason ≥3+4.
SPL on B-MRI had the highest sensitivity (95. 5%) and negative predictive value (NPV) of 71. 4% compared to PSA and PSAD. B-MRI significantly improved sensitivity (43. 2 to 72. 7%, p=0. 0002) when combined with PSAD. The NPV of PSA increased with B-MRI, achieving 91. 7% for B-MRI and PSA for Gleason ≥3+4. Overall accuracy of the composite equations was 81. 4% (B-MRI and PSA) and 78. 0% (B-MRI and PSAD).
Validation with a biopsy naïve cohort demonstrates the parameter SPL performed better than PSA or PSAD alone in accurately detecting PCa. The combined use of B-MRI, PSA, and PSAD resulted in improved accuracy for detecting clinically significant PCa.
Urology. 2015 Dec 08 [Epub ahead of print]
Michele Fascelli, Soroush Rais-Bahrami, Sandeep Sankineni, Anna M Brown, Arvin K George, Richard Ho, Thomas Frye, Amichai Kilchevsky, Raju Chelluri, Steven Abboud, M Minhaj Siddiqui, Maria J Merino, Bradford J Wood, Peter L Choyke, Peter A Pinto, Baris Turkbey
National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland; Departments of Urology and Radiology, University of Alabama at Birmingham. , National Cancer Institute, National Institutes of Health, Molecular Imaging Program, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Molecular Imaging Program, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland; Department of Surgery, Division of Urology, University of Maryland, Baltimore. , National Cancer Institute, National Institutes of Health, Laboratory of Pathology, Bethesda, Maryland. , Department of Radiology and Imaging Services, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Center for Interventional Oncology, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Molecular Imaging Program, Bethesda, Maryland. , Department of Radiology and Imaging Services, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Center for Interventional Oncology, Bethesda, Maryland; National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, Maryland. , National Cancer Institute, National Institutes of Health, Molecular Imaging Program, Bethesda, Maryland.