Prostate magnetic resonance imaging (MRI) and biomarkers are often used in conjunction to enhance the selection process for prostate biopsy. However, the optimal sequence of ordering these tests has not been established. A comprehensive evaluation was conducted on a large multi-institutional cohort of patients who underwent MRI, 4K score, and biopsy of the prostate to examine the impact of utilizing both tests vs. either test alone and to determine if the order in which these tests are administered affects the ability to detect clinically significant prostate cancer (csCaP).
We evaluated men from 8 different institutions who were referred for prostate cancer evaluation and underwent MRI, 4K score test, and prostate biopsy. The primary outcome was the presence of csCaP, defined as grade group 2 or higher cancer on a biopsy of the prostate. We used logistic regression, calibration plots, and decision curve analysis to evaluate using a 4K score or MRI alone vs. both tests together for detecting csCaP. In addition, we evaluated several strategies using one or both tests for selecting men for biopsy and compared them based on the proportion of biopsies avoided and the csCaP's missed.
Among the 1,111 men who formed the final cohort, 553 (49.8%) had prostate cancer, and 353 (31.8%) had csCaP. We found that using MRI and 4K score together had better discrimination, calibration, and a higher clinical utility on decision curve analysis compared to using either test individually. Using both tests together resulted in fewer biopsies avoided and missed cancers compared to using either test alone. Strategies that sequence MRI and 4K score tests resulted in the largest biopsy reduction, with no appreciable difference between starting with an MRI vs. a biomarker.
We found that using both an MRI and 4K score together was superior to using either test alone but found no appreciable difference between starting with an MRI vs. starting with a 4K score. Prospective studies are needed to identify the best strategy to sequence MRI and biomarkers in the evaluation of csCaP.
Urologic oncology. 2023 Aug 04 [Epub ahead of print]
Jamie Thomas, Shrikanth Atluri, Isaac Zucker, Isildinha Reis, Deukwoo Kwon, Eric Kim, Ashutosh Tewari, Vipul Patel, Vinayak Wagaskar, Badrinath Konety, Ali Kasraeian, Stefan Czarniecki, Gregory Thoreson, Nachiketh Soodana-Prakash, Chad Ritch, Bruno Nahar, Mark Gonzalgo, Bruce Kava, Dipen Parekh, Sanoj Punnen
Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL., Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL., Department of Surgery, Washington University School of Medicine, St. Louis, MO., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, FL., Allina Health Cancer Institute, Minneapolis, MN., Kasraeian Urology, Jacksonville, FL., HIFU Clinic, Department of Urology, St. Elizabeth Hospital, Warsaw, Poland., Urology Clinics of North Texas, Dallas, TX., Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL. Electronic address: .