Developing an effective strategy to improve the detection of significant prostate cancer by combining the 4Kscore and multiparametric MRI Journal Article

   

Authors:	Marzouk, K.; Ehdaie, B.; Vertosick, E.; Zappala, S.; Vickers, A.
Article Title:	Developing an effective strategy to improve the detection of significant prostate cancer by combining the 4Kscore and multiparametric MRI
Abstract:	Objectives: Recent years have seen the development of biomarkers and imaging technologies designed to improve the specificity of PSA. Widespread implementation of imaging technologies, such as mp-MRI raises considerable logistical challenges. Our objective was to evaluate a biopsy strategy that utilizes selective mp-MRI as a follow-up test to biomarkers to improve the detection of significant prostate cancer. Methods and Materials: We developed a conceptual approach based on the risk calculated from the 4Kscore using results from the US prospective validation study, multiplied by the likelihood ratio of mp-MRI from the PROMIS trial. The primary outcome was Gleason grade ≥ 7 (grade group ≥ 2) cancer on biopsy. Using decision curve analysis, the net benefit was determined for our model and compared with the use of the 4Kscore and mp-MRI independently at various thresholds for biopsy. Results: For a cut-point of 7.5% risk of high-grade disease, patients with <5% risk from a blood marker would not have risk of significant prostate cancer sufficiently increased by a positive mp-MRI to warrant biopsy; comparably, patients with a risk >23% would not have risk sufficiently reduced by a negative imaging study to forgo biopsy. From the 4Kscore validation study, 46% of men considered for biopsy in the US have risks 5% to 23%. Net benefit was highest for the combined strategy, followed by 4Kscore alone. Conclusions: Selective mp-MRI in men with intermediate scores on a secondary blood test results in a biopsy strategy that is more scalable than mp-MRI for all men with elevated PSA. Prospective validation is required to demonstrate if the predicted properties of combined blood and imaging testing are empirically confirmed. © 2019 Elsevier Inc.
Keywords:	magnetic resonance imaging; prostate cancer; prostate biopsy; 4kscore
Journal Title:	Urologic Oncology: Seminars and Original Investigations
Volume:	37
Issue:	10
ISSN:	1078-1439
Publisher:	Elsevier Inc.
Date Published:	2019-10-01
Start Page:	672
End Page:	677
Language:	English
DOI:	10.1016/j.urolonc.2019.07.010
PUBMED:	31378585
PROVIDER:	scopus
PMCID:	PMC6733611
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071713706&doi=10.1016%2fj.urolonc.2019.07.010&partnerID=40&md5=97153284df0bc7b8ff83c87885d904eb
Notes:	Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/153340