The study aims to identify the optimal 4Kscore thresholds to determine the need for a prostate biopsy when multiparametric magnetic resonance imaging (MRI) (mpMRI) is negative or indeterminate.
We analysed retrospective data from men in eight different institutions who underwent an mpMRI, 4Kscore and prostate biopsy for evaluation of prostate cancer. We selected men with a negative (PIRADS ≤2) or indeterminate (PIRADS 3) mpMRI. 4Kscore values were categorized into ranges of 1-7, 8-19, 20-32 and greater than 32. We evaluated the proportion of men with grade group 2 or higher (GG2+) cancer in groups defined by PIRADS and 4Kscore. We also evaluated the number of biopsies avoided and GG2+ cancer missed in each group reported depend on 4Kscore cutoff points.
Among 1111 men who had an mpMRI, 4Kscore and biopsy, 625 of them had PIRADS ≤3 on mpMRI: 374 negative (PIRADS ≤2) and 251 indeterminate (PIRADS 3). In men with a negative mpMRI, we found a 4Kscore cut-point of 33 resulted in an increased risk of GG2+ cancer on biopsy. In patients with an equivocal lesion on mpMRI, men with a 4Kscore cutoff ≥8 had a greater risk of GG2+ cancer on biopsy. Decision curve analysis supported the proposed cut-points in each mpMRI group.
In men with negative and indeterminate mpMRI, we found the best 4Kscore threshold to determine the need for biopsy to be 33 and 8 respectively. Future prospective studies in independent populations are needed to confirm these findings.
BJUI compass. 2023 May 01*** epublish ***
Ricardo de Almeida S, Jamie Thomas, Matthew M Mason, Maria F Becerra, Ali Merhe, Isildinha M Reis, Deukwoo Kwon, Nachiketh Soodana-Prakash, Ashutosh Tewari, Vipul Patel, Vinayak Wagaskar, Badrinath Konety, Ali Kasraeian, Stefan Czarniecki, Gregory R Thoreson, Eric H Kim, Sanjaya Swain, Dipen J Parekh, Sanoj Punnen
Desai Sethi Urology Institute, Miller School of Medicine, Sylvester Cancer Center University of Miami Miami Florida USA., School of Medicine University of Miami Miller Miami Florida USA., Division of Biostatistics, Department of Public Health Sciences, School of Medicine University of Miami Miller Miami Florida USA., Department of Urology Icahn School of Medicine at Mount Sinai New York New York USA., Global Robotics Institute, Florida Hospital-Celebration Health, College of Medicine University of Central Florida Orlando Florida USA., Department of Urology Icahn School of Medicine at Mount Sinai Hospital New York New York USA., Allina Health Cancer Institute Minneapolis Minnesota USA., Kasraeian Urology Jacksonville Florida USA., HIFU Clinic, Department of Urology St. Elizabeth Hospital Warsaw Poland., Urology Clinics of North Texas Dallas Texas USA., School of Medicine Washington University St. Louis Missouri USA.