Journal Article

A 4K score/MRI‐based nomogram for predicting prostate cancer, clinically significant prostate cancer, and unfavorable prostate cancer

Li, Li, Ratnani, Parita, Tewari, Ash, Wiklund, Peter, Lantz, Anna, Lewis, Sara, Sobotka, Stanislaw, Wagaskar, Vinayak G., Young, James, Falagario, Ugo Giovanni, Parekh, Sneha, Punnen, Sanoj, Haines, Kenneth

2021

Overview

Background The detection of prostate cancer requires histological confirmation in biopsy core. Currently, number of unnecessary prostate biopsies are being performed in the United States. This is due to the absence of appropriate biopsy decision‐making protocol. Aim To develop and validate a 4K score/multiparametric magnetic resonance imaging (mpMRI)‐based nomogram to predict prostate cancer (PCa), clinically significant prostate cancer (csPCa), and unfavorable prostate cancer (uPCa). Methods and Results Retrospective, single‐center study evaluating a cohort of 574 men with 4K score test >7% or suspicious digital rectal examination (DRE) or Prostate Imaging Reporting and Data System (PI‐RADS) scores 3, 4, or 5 on mpMRI that underwent systematic and/or mpMRI/ultrasound fusion–targeted prostate biopsy between 2016 and 2020. External cohort included 622 men. csPCa and uPCa were defined as Gleason score ≥3 + 4 and ≥4 + 3 on biopsy, respectively. Multivariable logistic regression analysis was performed to build nomogram for predicting PCa, csPCa, and uPCa. Validation was performed by plotting the area under the curve (AUC) and comparing nomogram‐predicted probabilities with actual rates of PCa, csPCa, and uPCa probabilities in the external cohort. 4K score, a PI‐RADS ≥4, prostate volume and prior negative biopsy were significant predictors of PCa, csPCa, and uPCa. AUCs were 0.84, 0.88, and 0.86 for the prediction of PCa, csPCa, and uPCa, respectively. The predicted and actual rates of PCa, csPCa, and uPCa showed agreement across all percentage probability ranges in the validation cohort. Using the prediction model at threshold of 30, 30% of overall biopsies, 41% of benign biopsies, and 19% of diagnosed indolent PCa could be avoided, while missing 9% of csPCa. Conclusion This novel nomogram would reduce unnecessary prostate biopsies and decrease detection of clinically insignificant PCa.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: 4K score test / Aged / Biomarkers / Biopsy / Biopsy, Large-Core Needle - statistics & numerical data / Clinical Decision-Making - methods / Clinical significance / Decision Support Techniques / Digital Rectal Examination / Family medical history / Humans / Magnetic resonance imaging / Male / Medical Overuse - prevention & control / Medical Overuse - statistics & numerical data / Middle Aged / Multimodal Imaging - methods / Multiparametric Magnetic Resonance Imaging / multiparametric MRI / Neoplasm Grading / Nomograms / Original / Performance evaluation / Prostate - diagnostic imaging / Prostate - pathology / Prostate cancer / Prostatic Neoplasms - diagnosis / Prostatic Neoplasms - epidemiology / Prostatic Neoplasms - pathology / Retrospective Studies / Risk Assessment - methods / Ultrasonography