A clinically significant prostate cancer predictive model using digital rectal examination prostate volume category to stratify initial prostate cancer suspicion and reduce magnetic resonance imaging demand

Morote, Juan; Borque-Fernando, Ángel; Triquell, Marina; Campistol, Miriam; Celma, Anna; Regis, Lucas; Abascal-Junquera, José María; Servian, Pol; Planas, Jacques; Mendez Fernández, Olga; Esteban, Luis M.; Trilla, Enrique

doi:http://dx.doi.org/10.3390/cancers14205100

A clinically significant prostate cancer predictive model using digital rectal examination prostate volume category to stratify initial prostate cancer suspicion and reduce magnetic resonance imaging demand

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Morote J, Borque-Fernando Á, Triquell M, Campistol M, Celma A, Regis L, et al. A clinically significant prostate cancer predictive model using digital rectal examination prostate volume category to stratify initial prostate cancer suspicion and reduce magnetic resonance imaging demand. Cancers (Basel). 2022 Oct 18; 14(20): 5100. DOI: 10.3390/cancers14205100

Abstract

A predictive model including age, PCa family history, biopsy status (initial vs repeat), DRE (normal vs abnormal), serum prostate-specific antigen (PSA), and DRE prostate volume ca-tegory was developed to stratify initial PCa suspicion in 1486 men with PSA > 3 ng/mL and/or abnormal DRE, in whom mpMRI followed; 2- to 4-core TRUS-guided biopsies where Prostate Imaging Report and Data System (PI-RADS) > 3 lesions and/or 12-core TRUS systematic biopsies were performed in one academic institution between 1 January 2016-31 December 2019. The csPCa detection rate, defined as International Society of Uro-Pathology grade group 2 or higher, was 36.9%. An external validation of designed BCN-RC 1 was carried out on 946 men from two other institutions in the same metropolitan area, using the same criteria of PCa suspicion and diagnostic approach, yielded a csPCa detection rate of 40.8%. The areas under the receiver operating characteristic curves of BCN-RC 1 were 0.823 (95% CI: 0.800-0.846) in the development cohort and 0.837 (95% CI: 0.811-0.863) in the validation cohort (p = 0.447). In both cohorts, BCN-RC 1 exhibited net benefit over performing mpMRI in all men from 8 and 12% risk thresholds, respectively. At 0.95 sensitivity of csPCa, the specificities of BCN-RC 1 were 0.24 (95% CI: 0.22-0.26) in the development cohort and 0.34 (95% CI: 0.31-0.37) in the validation cohort (p < 0.001). The percentages of avoided mpMRI scans were 17.2% in the development cohort and 22.3% in the validation cohort, missing between 1.8% and 2% of csPCa among men at risk of PCa. In summary, BCN-RC 1 can stratify initial PCa suspicion, reducing the demand of mpMRI, with an acceptable loss of csPCa.