1. A Model for Predicting Clinically Significant Prostate Cancer Using Prostate MRI and Risk Factors.
- Author
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Lacson R, Haj-Mirzaian A, Burk K, Glazer DI, Naik S, Khorasani R, and Kibel AS
- Subjects
- Male, Humans, Middle Aged, Risk Factors, Aged, Risk Assessment, Predictive Value of Tests, Neoplasm Grading, Prostate-Specific Antigen blood, Retrospective Studies, Biopsy, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms pathology, Magnetic Resonance Imaging methods
- Abstract
Purpose: The aim of this study was to develop and validate a predictive model for clinically significant prostate cancer (csPCa) using prostate MRI and patient risk factors., Methods: In total, 960 men who underwent MRI from 2015 to 2019 and biopsy either 6 months before or 6 months after MRI were identified. Men diagnosed with csPCa were identified, and csPCa risk was modeled using known patient factors (age, race, and prostate-specific antigen [PSA] level) and prostate MRI findings (location, Prostate Imaging Reporting and Data System score, extraprostatic extension, dominant lesion size, and PSA density). csPCa was defined as Gleason score sum ≥ 7. Using a derivation cohort, a multivariable logistic regression model and a point-based scoring system were developed to predict csPCa. Discrimination and calibration were assessed in a separate independent validation cohort., Results: Among 960 MRI reports, 552 (57.5%) were from men diagnosed with csPCa. Using the derivation cohort (n = 632), variables that predicted csPCa were Prostate Imaging Reporting and Data System scores of 4 and 5, the presence of extraprostatic extension, and elevated PSA density. Evaluation using the validation cohort (n = 328) resulted in an area under the curve of 0.77, with adequate calibration (Hosmer-Lemeshow P = .58). At a risk threshold of >2 points, the model identified csPCa with sensitivity of 98.4% and negative predictive value of 78.6% but prevented only 4.3% potential biopsies (0-2 points; 14 of 328). At a higher threshold of >5 points, the model identified csPCa with sensitivity of 89.5% and negative predictive value of 70.1% and avoided 20.4% of biopsies (0-5 points; 67 of 328)., Conclusions: The point-based model reported here can potentially identify a vast majority of men at risk for csPCa, while avoiding biopsy in about 1 in 5 men with elevated PSA levels., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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