Abbreviated Versus Multiparametric Prostate MRI in Active Surveillance for Prostate-Cancer Patients: Comparison of Accuracy and Clinical Utility As a Decisional Tool

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2023 Feb 25

PMID 36832066

Authors

Fabio Zattoni

Silvio Maresca

Fabrizio Dal Moro

Iliana Bednarova

Gianmarco Randazzo

Giovanni Basso

Giuseppe Reitano

Gianluca Giannarini

Chiara Zuiani

Rossano Girometti

Affiliations

Soon will be listed here.

Abstract

(1) Purpose: To compare the diagnostic accuracy between full multiparametric contrast-enhanced prostate MRI (mpMRI) and abbreviated dual-sequence prostate MRI (dsMRI) in men with clinically significant prostate cancer (csPCa) who were candidates for active surveillance. (2) Materials and Methods: Fifty-four patients with a diagnosis of low-risk PCa in the previous 6 months had a mpMRI scan prior to a saturation biopsy and a subsequent MRI cognitive transperineal targeted biopsy (for PI-RADS ≥ 3 lesions). The dsMRI images were obtained from the mpMRI protocol. The images were selected by a study coordinator and assigned to two readers blinded to the biopsy results (R1 and R2). Inter-reader agreement for clinically significant cancer was evaluated with Cohen's kappa. The dsMRI and mpMRI accuracy was calculated for each reader (R1 and R2). The clinical utility of the dsMRI and mpMRI was investigated with a decision-analysis model. (3) Results: The dsMRI sensitivity and specificity were 83.3%, 31.0%, 75.0%, and 23.8%, respectively, for R1 and R2. The mpMRI sensitivity and specificity were 91.7%, 31.0%, 83.3%, and 23.8%, respectively, for R1 and R2. The inter-reader agreement for the detection of csPCa was moderate (k = 0.53) and good (k = 0.63) for dsMRI and mpMRI, respectively. The AUC values for the dsMRI were 0.77 and 0.62 for the R1 and R2, respectively. The AUC values for the mpMRI were 0.79 and 0.66 for R1 and R2, respectively. No AUC differences were found between the two MRI protocols. At any risk threshold, the mpMRI showed a higher net benefit than the dsMRI for both R1 and R2. (4) Conclusions: The dsMRI and mpMRI showed similar diagnostic accuracy for csPCa in male candidates for active surveillance.

References

Nassiri N, Margolis D, Natarajan S, Sharma D, Huang J, Dorey F . Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate Cancer. J Urol. 2016; 197(3 Pt 1):632-639. PMC: 5315577. DOI: 10.1016/j.juro.2016.09.070. View

Bjurlin M, Wysock J, Taneja S . Optimization of prostate biopsy: review of technique and complications. Urol Clin North Am. 2014; 41(2):299-313. PMC: 4151475. DOI: 10.1016/j.ucl.2014.01.011. View

van der Leest M, Israel B, Cornel E, Zamecnik P, Schoots I, van der Lelij H . High Diagnostic Performance of Short Magnetic Resonance Imaging Protocols for Prostate Cancer Detection in Biopsy-naïve Men: The Next Step in Magnetic Resonance Imaging Accessibility. Eur Urol. 2019; 76(5):574-581. DOI: 10.1016/j.eururo.2019.05.029. View

Osses D, Drost F, Verbeek J, Luiting H, van Leenders G, Bangma C . Prostate cancer upgrading with serial prostate magnetic resonance imaging and repeat biopsy in men on active surveillance: are confirmatory biopsies still necessary?. BJU Int. 2020; 126(1):124-132. PMC: 7383866. DOI: 10.1111/bju.15065. View

Cicchetti D, Bronen R, Spencer S, Haut S, Berg A, Oliver P . Rating scales, scales of measurement, issues of reliability: resolving some critical issues for clinicians and researchers. J Nerv Ment Dis. 2006; 194(8):557-64. DOI: 10.1097/01.nmd.0000230392.83607.c5. View

Vickers A, Elkin E . Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making. 2006; 26(6):565-74. PMC: 2577036. DOI: 10.1177/0272989X06295361. View

Vickers A, Van Calster B, Steyerberg E . A simple, step-by-step guide to interpreting decision curve analysis. Diagn Progn Res. 2019; 3:18. PMC: 6777022. DOI: 10.1186/s41512-019-0064-7. View

Chandrasekar T, DallEra M, Tilki D . Multiparametric MRI: an important tool to improve risk stratification for active surveillance in prostate cancer. BJU Int. 2018; 122(5):721-722. DOI: 10.1111/bju.14494. View

Abdollah F, Novara G, Briganti A, Scattoni V, Raber M, Roscigno M . Trans-rectal versus trans-perineal saturation rebiopsy of the prostate: is there a difference in cancer detection rate?. Urology. 2010; 77(4):921-5. DOI: 10.1016/j.urology.2010.08.048. View

10.

Frye T, George A, Kilchevsky A, Maruf M, Siddiqui M, Kongnyuy M . Magnetic Resonance Imaging-Transrectal Ultrasound Guided Fusion Biopsy to Detect Progression in Patients with Existing Lesions on Active Surveillance for Low and Intermediate Risk Prostate Cancer. J Urol. 2016; 197(3 Pt 1):640-646. PMC: 7951787. DOI: 10.1016/j.juro.2016.08.109. View

11.

de Rooij M, Israel B, Tummers M, Ahmed H, Barrett T, Giganti F . ESUR/ESUI consensus statements on multi-parametric MRI for the detection of clinically significant prostate cancer: quality requirements for image acquisition, interpretation and radiologists' training. Eur Radiol. 2020; 30(10):5404-5416. PMC: 7476997. DOI: 10.1007/s00330-020-06929-z. View

12.

King A, Livermore A, Laurila T, Huang W, Jarrard D . Impact of immediate TRUS rebiopsy in a patient cohort considering active surveillance for favorable risk prostate cancer. Urol Oncol. 2011; 31(6):739-43. PMC: 4209721. DOI: 10.1016/j.urolonc.2011.06.011. View

13.

Mohler J, Antonarakis E, Armstrong A, DAmico A, Davis B, Dorff T . Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019; 17(5):479-505. DOI: 10.6004/jnccn.2019.0023. View

14.

Zattoni F, Morlacco A, Soligo M, Mancini M, Leone N, Zecchini G . Diagnosis of clinically significant prostate cancer after negative multiparametric magnetic resonance imaging. Cent European J Urol. 2022; 75(3):277-283. PMC: 9628724. DOI: 10.5173/ceju.2022.0092. View

15.

Inoue L, Lin D, Newcomb L, Leonardson A, Ankerst D, Gulati R . Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance Cohorts. Ann Intern Med. 2017; 168(1):1-9. PMC: 5752581. DOI: 10.7326/M17-0548. View

16.

Weinreb J, Barentsz J, Choyke P, Cornud F, Haider M, Macura K . PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2015; 69(1):16-40. PMC: 6467207. DOI: 10.1016/j.eururo.2015.08.052. View

17.

Girometti R, Cereser L, Bonato F, Zuiani C . Evolution of prostate MRI: from multiparametric standard to less-is-better and different-is better strategies. Eur Radiol Exp. 2019; 3(1):5. PMC: 6890868. DOI: 10.1186/s41747-019-0088-3. View

18.

Barentsz J, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G . ESUR prostate MR guidelines 2012. Eur Radiol. 2012; 22(4):746-57. PMC: 3297750. DOI: 10.1007/s00330-011-2377-y. View

19.

Schoots I, Nieboer D, Giganti F, Moore C, Bangma C, Roobol M . Is magnetic resonance imaging-targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low-risk prostate cancer? A systematic review and meta-analysis. BJU Int. 2018; 122(6):946-958. DOI: 10.1111/bju.14358. View

20.

Moldovan P, Van den Broeck T, Sylvester R, Marconi L, Bellmunt J, van den Bergh R . What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. Eur Urol. 2017; 72(2):250-266. DOI: 10.1016/j.eururo.2017.02.026. View