Beyond Prostate Imaging Reporting and Data System: Combining Magnetic Resonance Imaging Prostate Imaging Reporting and Data System and Prostate-Specific Membrane Antigen-Positron Emission Tomography/Computed Tomography PRIMARY Score in a Composite (P) Score for More Accurate Diagnosis of Clinically Significant Prostate Cancer

Emmett, L; Papa, N; Hope, TA; Fendler, W; Calais, J; Burger, I; Eiber, M; Barbato, F; Moon, D; Counter, W; John, N; Xue, A; Franklin, A; Thompson, J; Rasiah, K; Frydenberg, M; Yaxley, J; Buteau, J; Agrawal, S; Ho, B; Nguyen, A; Liu, V; Lee, J; Woo, H; Hsiao, E; Sutherland, T; Perry, E; Stricker, P; Hofman, MS; Kasivisvanathan, V; Roberts, M; Murphy, D

Author(s): Emmett, L; Papa, N; Hope, TA; Fendler, W; Calais, J; Burger, I; Eiber, M; Barbato, F; Moon, D; Counter, W; John, N; Xue, A; Franklin, A; Thompson, J; Rasiah, K; Frydenberg, M; Yaxley, J; Buteau, J; Agrawal, S; Ho, B; Nguyen, A; Liu, V; Lee, J; Woo, H; Hsiao, E; Sutherland, T; Perry, E; Stricker, P; Hofman, MS; Kasivisvanathan, V; Roberts, M; Murphy, D;
Details: Publication Year 2024-08,Volume 212,Issue #2,Page 299-309
Journal Title: Journal of Urology
Publication Type: Research article
Abstract: PURPOSE: The Prostate Imaging Reporting and Data System (PI-RADS) score is standard of care for clinically significant prostate cancer (csPCa) diagnosis. The PRIMARY score (prostate-specific membrane antigen [PSMA]-positron emission tomography [PET]/CT) also has high diagnostic accuracy for csPCa. This study aimed to develop an easily calculated combined (P) score for csPCa detection (International Society of Urological Pathology [ISUP] ≥2) incorporating separately read PI-RADS and PRIMARY scores, with external validation. MATERIALS AND METHODS: Two datasets of men with suspected PCa, no prior biopsy, recent MRI and (68)Ga-PSMA-11-PET/CT, and subsequent transperineal biopsy were evaluated. These included the development sample (n = 291, 56% csPCa) a prospective trial and the validation sample (n = 227, 67% csPCa) a multicenter retrospective database. Primary outcome was detection of csPCa (ISUP ≥2), with ISUP ≥ 3 cancer detection a secondary outcome. Score performance was evaluated by area under the curve, sensitivity, specificity, and decision curve analysis. RESULTS: The 5-point combined (P) score was developed in a prospective dataset. In the validation dataset, csPCa was identified in 0%, 20%, 52%, 96%, and 100% for P score 1 to 5. The area under the curve was 0.93 (95% CI: 0.90-0.96), higher than PI-RADS 0.89 (95% CI: 0.85-0.93, P = .039) and PRIMARY score alone 0.84 (95% CI: 0.79-0.89, P < .001). Splitting scores at 1/2 (negative) vs 3/4/5 (positive), P score sensitivity was 94% (95% CI: 89-97) compared to PI-RADS 89% (95% CI: 83-93) and PRIMARY score 86% (95% CI: 79-91). For ISUP ≥ 3, P score sensitivity was 99% (95% CI: 95-100) vs 94% (95% CI: 88-98) and 92% (95% CI: 85-97) for PI-RADS and PRIMARY scores respectively. A maximum standardized uptake value > 12 (P score 5) was ISUP ≥ 2 in all cases with 93% ISUP ≥ 3. CONCLUSIONS: The P score is easily calculated and improves accuracy for csPCa over both PI-RADS and PRIMARY scores. It should be considered when PSMA-PET is undertaken for diagnosis.
Publisher: Wolters Kluwer
Keywords: Humans; Male; *Prostatic Neoplasms/diagnostic imaging/pathology; *Positron Emission Tomography Computed Tomography/methods; *Magnetic Resonance Imaging/methods; Aged; Middle Aged; Retrospective Studies; Prospective Studies; Data Systems; Prostate/diagnostic imaging/pathology; Pet; diagnosis; multi-parametric MRI; prostate cancer; prostate specific membrane antigen
Department(s): Surgical Oncology; Cancer Imaging
Publisher's Version: https://doi.org/10.1097/ju.0000000000004010
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-08-01 05:00:15

Last Modified: 2024-08-01 05:00:43