A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Design, Setting, and Participants
2.2. MRI and Prostate Biopsy
2.3. Outcome Variable
2.4. Candidate Predictive Variables for the Concordance Degree of csPCa Detection between Systematic and Targeted Biopsies
2.5. Statistical Analysis
3. Results
3.1. Characteristics of the Study Cohort
3.2. Analysis of Concordance between Systematic and Targeted Biopsies according to the Detection of csPCa
3.3. Univariate and Multivariate Analyses of Candidate Predictive Variables for the Concordance Degree of csPCa in Systematic and Targeted Biopsies
3.4. Development of a Predictive Model for the Discrimination Ability of Targeted Biopsies to Detect csPCa
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Measurement |
---|---|
Number of men, n | 2122 |
Median age, years (IQR) | 68 (62–73) |
Median serum PSA, ng/mL (IQR) | 7.3 (5.2–11.0) |
Abnormal DRE, n (%) | 570 (26.9) |
Repeat prostate biopsy, n (%) | 708 (33.4%) |
PCa family history, n (%) | 154 (7.3) |
Median prostate volume, mL (IQR) | 53 (39–95) |
3 Tesla mpMRI, n (%) | 1493 (70.5) |
PI-RADS 3, n (%) | 485 (22.9) |
PI-RADS 4, n (%) | 1146 (54.0) |
PI-RADS 5, n (%) | 491 (23.1) |
Software TRUS-MRI image fusion, n (%) | 1224 (57.7) |
Transperineal route, n (%) | 1286 (60.6) |
ISUP grade group of detected tumours, n (%) | |
1 | 398 (27.9) |
2 | 522 (36.7) |
3 | 184 (12.9) |
4 | 172 (12.1) |
5 | 148 (10.4) |
PCa, n (%) | 1424 (67.1) |
csPCa, n (%) | 1026 (48.4) |
Number of Men | Discordance n (%) | CsPCa in Systematic and Targeted Biopsies n (%) | |||
---|---|---|---|---|---|
− − | − + | + − | + + | ||
2122 | 509 (24.0) | 1096 (51.6) | 366 (17.3) | 143 (6.7) | 517 (24.4) |
p < 0.001 |
Predictive Variable | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
Odds Ratio (95% CI) | p Value | Odds Ratio (95% CI) | p Value | |
Age, ref. ≤68 years | 1.464(1.119–1.789) | <0.001 | 1.480 (1.182–1.803) | <0.001 |
Serum PSA, ref. ≤7.3 ng/mL | 0.972 (0.786–1.186) | 0.777 | 0.893 (0.722–1.105) | 0.299 |
DRE, ref. normal | 1.233 (0.989–1.536) | 0.066 | 1.087 (0.856–1.379) | 0.493 |
Type of biopsy, ref. initial | 1.112 (0.901–1.371) | 0.323 | 1.176 (0.939–1.473) | 0.159 |
PCa family history, ref. no | 1.205 (0.833–1.744) | 0.312 | 1.306 (0.888–1.921) | 0.175 |
Prostate volume, ref. ≤53 mL | 0.570 (0.465–0.698) | <0.001 | 0.582 (0.470–0.720) | <0.001 |
Type of mpMRI, ref. 1.5 Tesla | 1.274 (1.017–1.596) | <0.001 | 1.463 (1.148–1.865) | 0.002 |
PI-RADS category, ref. 3 | 1.690 (1.431–1.956) | <0.001 | 1.590 (1.352–1.870) | <0.001 |
Type of TRUS-MRI fusion technique, ref. visual | 1.483 (1.206–1.823) | <0.001 | 1.333 (1.046–1.701) | 0.020 |
Prostate biopsy approach, ref. transrectal | 1.592 (1.288–1.968) | <0.001 | 1.335 (1.052–1.694) | 0.018 |
According to: | Number of Men | Discordance | p Value | Only in TB | Only in SB | p Value |
---|---|---|---|---|---|---|
Age: | ||||||
≤68 years, n (%) | 1087 | 224 (20.6) | <0.001 | 162 (14.9) | 62 (5.7) | <0.001 |
>68 years, n (%) | 1035 | 285 (27.5) | 204 (19.7) | 81 (7.8) | <0.001 | |
Serum PSA: | ||||||
≤7.3 ng/mL, n (%) | 1064 | 258 (24.2) | 0.777 | 191 (18.0) | 67 (6.3) | <0.001 |
>7.3 ng/mL, n (%) | 1058 | 251 (23.7) | 175 (16.5) | 76 (7.2) | <0.001 | |
DRE: | ||||||
Normal, n (%) | 1552 | 356 (22.9) | 0.062 | 268 (17.3) | 88 (5.7) | <0.001 |
Abnormal, n (%) | 570 | 153 (26.8) | 98 (17.2) | 55 (9.6) | <0.001 | |
Type of biopsy: | ||||||
Initial, n (%) | 1414 | 330 (23.3) | 0.323 | 238 (16.8) | 92 (6.5) | <0.001 |
Repeat, n (%) | 708 | 179 (15.6) | 128 (18.1) | 51 (7.2) | <0.001 | |
PCa family history: | ||||||
No | 1968 | 467 (23.7) | 0.328 | 330 (16.8) | 127 (7.0) | <0.001 |
Yes | 154 | 42 (27.3) | 36 (23.4) | 6 (3.9) | <0.001 | |
Prostate volume: | ||||||
≤53 mL, n (%) | 1064 | 309 (29.0) | <0.001 | 225 (21.1) | 84 (7.3) | <0.001 |
>53 mL, n (%) | 1058 | 200 (18.9) | 141 (13.3) | 59 (5.6) | <0.001 |
According to: | Number of Men | Discordance | p Value | Only in TB | Only in SB | p Value |
---|---|---|---|---|---|---|
MRI Tesla scan | ||||||
1.5 Tesla | 625 | 131 (21.0) | 0.035 | 84 (13.4) | 47 (7.5) | <0.001 |
3.0 Tesla | 1497 | 378 (25.3) | 282 (18.8) | 96 (6.4) | <0.001 | |
PI-RADS score: | ||||||
PI-RADS 3, n (%) | 485 | 56 (11.5) | <0.001 | 24 (4.9) | 32 (6.6) | <0.001 |
PI-RADS 4, n (%) | 1146 | 301 (26.3) | 215 (18.8) | 86 (7.5) | <0.001 | |
PI-RADS 5, n (%) | 491 | 152 (31.0) | 127 (25.9) | 25 (5.1) | <0.001 | |
Biopsy route: | ||||||
Transrectal, n (%) | 836 | 159 (19.0) | <0.001 | 85 (10.2) | 74 (8.9) | <0.001 |
Transperineal, n (%) | 1286 | 350 (27.2) | 281 (21.9) | 69 (5.4) | <0.001 | |
MRI-TRUS fusion technique: | ||||||
Cognitive, n (%) | 836 | 159 (19.0) | <0.001 | 103 (11.5) | 76 (8.5) | <0.001 |
Software, n (%) | 1286 | 350 (27.0) | 263 (21.5) | 67 (5.5) | <0.001 |
Threshold | Sensitivity (%) | Specificity (%) | Avoided SB (%) | Undetected csPCa (%) |
---|---|---|---|---|
0.038 | 100 | 5.8 | 11 (0.5) | 0 |
0.061 | 97.5 | 22.5 | 312 (14.7) | 25 (2.4) |
0.071 | 95.0 | 27.4 | 388 (18.3) | 47 (4.6) |
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Morote, J.; Picola, N.; Muñoz-Rodriguez, J.; Paesano, N.; Ruiz-Plazas, X.; Muñoz-Rivero, M.V.; Celma, A.; Manuel, G.G.-d.; Aisian, I.; Servian, P.; et al. A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies. Cancers 2023, 15, 4543. https://doi.org/10.3390/cancers15184543
Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, Manuel GG-d, Aisian I, Servian P, et al. A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies. Cancers. 2023; 15(18):4543. https://doi.org/10.3390/cancers15184543
Chicago/Turabian StyleMorote, Juan, Natàlia Picola, Jesús Muñoz-Rodriguez, Nahuel Paesano, Xavier Ruiz-Plazas, Marta V. Muñoz-Rivero, Anna Celma, Gemma García-de Manuel, Ignacio Aisian, Pol Servian, and et al. 2023. "A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies" Cancers 15, no. 18: 4543. https://doi.org/10.3390/cancers15184543