PURPOSE: In patients with a negative prostate biopsy (PB) and persistent suspicion of prostate cancer (PCa), additional analyses such as the PCA3 score, Prostate Health Index (PHI) and multiparametric Magnetic Resonance Imaging (mp-MRI) have been proposed for reducing the number of unnecessary repeated biopsies.
Objective of the study was to evaluate the diagnostic accuracy of PCA3, PHI, mp-MRI, and different combinations of these tests in the repeated biopsy (RB) setting.
MATERIALS AND METHODS: 170 patients with an initial negative PB and persistent suspicion of PCa were enrolled in this prospective study. The patients underwent measurements of the total PSA and free PSA rate, along with PHI, PCA3 tests, and mp-MRI prior to standard RB that was performed by urologists blinded to the mp-MRI results. Multivariable logistic regression models with different combinations of PCA3, PHI, and mp-MRI were used to identify the predictors of PCa with RB, and the performances of these models were compared using ROC curves, AUC analysis, and decision curve analysis (DCA).
RESULTS: In the ROC analysis, the most significant contribution was provided by mp-MRI (AUC value of 0.936), which was greater than the contribution of the PHI+PCA3 model (p< 0.001). In the multivariate logistic regression analysis, only mp-MRI was a significant independent predictor of PCa diagnosis with RB (p< 0.001). The results of the DCA confirmed that the most significant improvement in the net benefit was provided by mp-MRI.
CONCLUSIONS: Mp-MRI provides high diagnostic accuracy in identifying patients with PCa in the RB setting compared with PCA3 and PHI.
Written by:
Porpiglia F, Russo F, Manfredi M, Mele F, Fiori C, Bollito E, Papotti M, Molineris I, Passera R, Regge D. Are you the author?
1Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy; Radiology Unit, Institute for Cancer Research and Treatment, Strada Provinciale 142, 10060 Candiolo, Turin, Italy; Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza 52, 10126 Turin, Italy; Division of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Corso Bramante 88, 10126 Turin, Italy.
Reference: J Urol. 2014 Feb 8. pii: S0022-5347(14)00052-4.
doi: 10.1016/j.juro.2014.01.030
PubMed Abstract
PMID: 24518780
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