CLINICAL DECISION ALGORITHM USING RESTRICTION SPECTRUM IMAGING AND BIOMARKERS TO PREDICT UPGRADING IN ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 May 2022PD40-07 CLINICAL DECISION ALGORITHM USING RESTRICTION SPECTRUM IMAGING AND BIOMARKERS TO PREDICT UPGRADING IN ACTIVE SURVEILLANCE Stefan Eng, Benjamin Basasie, Alfonso Lam, John Semmes, Dean Troyer, Geoffrey Clarke, Abhijit Sunnapwar, Robin Leach, Teresa Johnson-Pais, Lori Sokoll, Daniel Chan, Jeffrey Tosoian, Javed Siddiqui, Arul Chinnaiyan, Paul Boutros, and Michael Liss Stefan EngStefan Eng More articles by this author , Benjamin BasasieBenjamin Basasie More articles by this author , Alfonso LamAlfonso Lam More articles by this author , John SemmesJohn Semmes More articles by this author , Dean TroyerDean Troyer More articles by this author , Geoffrey ClarkeGeoffrey Clarke More articles by this author , Abhijit SunnapwarAbhijit Sunnapwar More articles by this author , Robin LeachRobin Leach More articles by this author , Teresa Johnson-PaisTeresa Johnson-Pais More articles by this author , Lori SokollLori Sokoll More articles by this author , Daniel ChanDaniel Chan More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Javed SiddiquiJaved Siddiqui More articles by this author , Arul ChinnaiyanArul Chinnaiyan More articles by this author , Paul BoutrosPaul Boutros More articles by this author , and Michael LissMichael Liss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002601.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine the relative value and optimal combination of radiologic and molecular biomarkers to predict prostate cancer progression in men on active surveillance. METHODS: We prospectively enrolled 123 men with prostate cancer on active surveillance who were undergoing repeat biopsy to obtain an MRI and non-invasive biomarkers that predict the risk of upgrading. Subjects underwent a prostate multiparametric MRI and a short duration, diffusion-weighted enhanced MRI called restriction spectrum imaging (RSI) to generate a restricted signal map (RSM) along with evaluation of 30 features (14 clinico-epidemiologic features, 9 molecular biomarkers and 7 radiologic-associated features). Our primary outcome was upgrading to higher grade disease on subsequent active surveillance prostate biopsy. Statistical analysis evaluated AUROC and AUPRC, and improvements in these. Using the data, we then devised a clinical decision algorithm to best predict upgrading using the tested biomarkers. RESULTS: RSM (RSI-MRI biomarker) was the most accurate single biomarker in predicting upgrading at the subsequent active surveillance biopsy (AUROC=0.84; 95%CI: 0.71-0.96). RSI improved a baseline clinical model that included MRI PIRADSv2 scores from an AUROC of 0.74 (95%CI 0.69-0.80) to 0.84 (95% CI 0.79–0.89). The best non-imaging biomarker was the prostate volume corrected Prostate Health Index (PHI) density (AUROC=0.68; 95%CI: 0.53-0.82). Combining these with age as a clinical decision tree to perform or not perform a biopsy using cross validated statistics we reach an AUC of the model at 0.8 (SD 0.18). CONCLUSIONS: Enhancement of diffusion-weighted imaging using RSI in addition to standard PIRADSv2 scoring, PHI, and age provides improvement to the predictive ability of MRI to detect upgrading in active surveillance. A combination of multiple biomarkers in a clinical decision tree improves prediction of groups at high risk for future upgrading. Source of Funding: Department of Defense © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e686 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefan Eng More articles by this author Benjamin Basasie More articles by this author Alfonso Lam More articles by this author John Semmes More articles by this author Dean Troyer More articles by this author Geoffrey Clarke More articles by this author Abhijit Sunnapwar More articles by this author Robin Leach More articles by this author Teresa Johnson-Pais More articles by this author Lori Sokoll More articles by this author Daniel Chan More articles by this author Jeffrey Tosoian More articles by this author Javed Siddiqui More articles by this author Arul Chinnaiyan More articles by this author Paul Boutros More articles by this author Michael Liss More articles by this author Expand All Advertisement PDF downloadLoading ...