MP03-02 COMBINED CLINICAL PARAMETERS AND MULTIPARAMETRIC MRI FOR ADVANCED RISK MODELING OF PROSTATE CANCER - PATIENT-TAILORED RISK STRATIFICATION CAN REDUCE UNNECESSARY BIOPSIES

You have accessJournal of UrologyProstate Cancer: Detection & Screening I1 Apr 2017MP03-02 COMBINED CLINICAL PARAMETERS AND MULTIPARAMETRIC MRI FOR ADVANCED RISK MODELING OF PROSTATE CANCER - PATIENT-TAILORED RISK STRATIFICATION CAN REDUCE UNNECESSARY BIOPSIES Jan Philipp Radtke, Bonekamp David, Claudia Kesch, Martin Freitag, Bertram Hitthaler, Matthias Claudius Roethke, Celine Alt, Kathrin Wieczorek, Wilfried Roth, Stefan Duensing, Dogu Teber, Heinz-Peter Schlemmer, Markus Hohenfellner, and Boris Hadaschik Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Bonekamp DavidBonekamp David More articles by this author , Claudia KeschClaudia Kesch More articles by this author , Martin FreitagMartin Freitag More articles by this author , Bertram HitthalerBertram Hitthaler More articles by this author , Matthias Claudius RoethkeMatthias Claudius Roethke More articles by this author , Celine AltCeline Alt More articles by this author , Kathrin WieczorekKathrin Wieczorek More articles by this author , Wilfried RothWilfried Roth More articles by this author , Stefan DuensingStefan Duensing More articles by this author , Dogu TeberDogu Teber More articles by this author , Heinz-Peter SchlemmerHeinz-Peter Schlemmer More articles by this author , Markus HohenfellnerMarkus Hohenfellner More articles by this author , and Boris HadaschikBoris Hadaschik More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.119AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric MRI (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC) detection (Gleason-score >= 3+4). Decision making based on European Randomised study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome PSA-screening limitations. We added pre-biopsy mpMRI to ERSPC-RC parameters and developed a risk model (RM) to predict individual sPC-risk on biopsy. METHODS We retrospectively analyzed clinical parameters of 755 men (biopsy-naive or after previous biopsy) who underwent mpMRI prior to MRI/TRUS-fusion-biopsy between 2012 and 2014 as training sample. The RM was validated in 404 consecutive patients in 2015. A stepwise multivariate regression analysis was used to determine significant sPC-predictors in the training set and to develop the RM. The accuracy was compared to ERSPC-RC3 (for biopsy-naive men) and 4 (for patients after previous biopsy) and PI-RADSv1.0 scoring using receiver operating characteristics (ROC). Discrimination and calibration of the RM, as well as net decision and reduction curve analyses were evaluated in validation set. RESULTS PSA, prostate volume, digital-rectal examination and PI-RADS were significant sPC-predictors and included in the RM (Figure a). ROC area under the curve (AUC) for the RM was significantly larger (0.82 each), compared to ERSPC-RC3 (0.79, p=0.004), RC4 (0.68, p<0.001) and PI-RADS (0.74-76, p=0.015 and p=0.006) (Figure b-e). Similarly, in the validation cohort, RM's discrimination was higher for biopsy-naive and post-biopsy men (0.84 and 0.76), compared to PI-RADS (0.76 and 0.69, p=0.002 and p=0.006) and ERSPC-RC3/4 (0.79/0.74, p=0.003/p=0.146). The calibration plot demonstrated an excellent slope (1.03)(Figure f). The RM's benefit exceeded that of ERSPC-RCs and PI-RADS in the decision which patient to biopsy and enabled the highest reduction rate of unnecessary biopsies. CONCLUSIONS The novel RM, incorporating ERSPC-RC parameters and PI-RADS, performed significantly better compared to the tools alone and provides measurable benefit in making the decision to biopsy men at suspicion of PC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e19 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jan Philipp Radtke More articles by this author Bonekamp David More articles by this author Claudia Kesch More articles by this author Martin Freitag More articles by this author Bertram Hitthaler More articles by this author Matthias Claudius Roethke More articles by this author Celine Alt More articles by this author Kathrin Wieczorek More articles by this author Wilfried Roth More articles by this author Stefan Duensing More articles by this author Dogu Teber More articles by this author Heinz-Peter Schlemmer More articles by this author Markus Hohenfellner More articles by this author Boris Hadaschik More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...