Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
JU INSIGHT Combining MRI PI-RADS and Prostate-Specific Membrane Antigen–PET/CT PRIMARY Score in a Composite Score
By: Louise Emmett, MD, St Vincent’s Hospital, Sydney, Australia, Garvan Institute of Medical Research, Sydney, Australia, St Vincent’s Clinical School, University of New South Wales, Sydney, Australia; Nathan Papa, BCom, MBBS, MEpi, PhD, Garvan Institute of Medical Research, Sydney, Australia; Thomas A. Hope, MD, University of California, San Francisco; Wolfgang Fendler, MD, University of Duisburg-Essen and German Cancer Consortium (DKTK)–University Hospital, Germany; Jeremie Calais, MD, MSc, David Geffen School of Medicine at UCLA; Irene Burger, MD, Kantonsspital Baden, Switzerland; Matthias Eiber, MD, PhD, School of Medicine, Technical University Munich, Germany; Francesco Barbato, MD, University of Duisburg-Essen and German Cancer Consortium (DKTK)–University Hospital, Germany; Daniel Moon, MBBS, Peter MacCallum Cancer Centre, Melbourne, Australia; William Counter, MD, PhD, St Vincent’s Hospital, Sydney, Australia; Nikeith John, MBBS, St Vincent’s Hospital, Sydney, Australia, St Vincent’s Clinical School, University of New South Wales, Sydney, Australia; Alan Xue, MBBS, Monash University, Melbourne, Australia; Anthony Franklin, MBBS, Royal Brisbane and Women’s Hospital, Australia; James Thompson, MBBS, Garvan Institute of Medical Research, Sydney, Australia, St Vincent’s Hospital, Sydney, Australia; Kris Rasiah, MBBS, Royal North Shore Hospital, Sydney, Australia; Mark Frydenberg, MBBS, Monash University, Melbourne, Australia; John Yaxley, MBBS, The Wesley Hospital, Brisbane, Australia; James Buteau, PhD, Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia; Shikha Agrawal, MBBS, St Vincent’s Hospital, Sydney, Australia, Garvan Institute of Medical Research, Sydney, Australia; Bao Ho, MBBS, St Vincent’s Hospital, Sydney, Australia; Andrew Nguyen, MBBS, St Vincent’s Hospital, Sydney, Australia; Victor Liu, MBBS, St Vincent’s Hospital, Sydney, Australia; Jonathan Lee, MBBS, St Vincent’s Hospital, Sydney, Australia; Henry Woo, MBBS, DMedSc, Chris O’Brien Lifehouse, Sydney, Australia; Edward Hsiao, MD, PhD, Chris O’Brien Lifehouse, Sydney, Australia; Thomas Sutherland, MBBS, MMed, St Vincent’s Hospital, Melbourne, Australia; Elyse Perry, MBBS, St Vincent’s Hospital, Sydney, Australia; Phillip Stricker, MBBS, St Vincent’s Hospital, Melbourne, Australia; Michael S. Hofman, MBBS, Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, Australia, University of Melbourne, Australia; Veeru Kasivisvanathan, PhD, University College London, United Kingdom; Matthew Roberts, BSc, MBBS, PhD, University of Duisburg-Essen and German Cancer Consortium (DKTK)–University Hospital, Germany; Declan Murphy, MB, BCh, BAO, Peter MacCallum Cancer Centre, Melbourne, | Posted on: 14 Aug 2024
Emmett L, Papa N, Hope TA, et al. Beyond PI-RADS: combining magnetic resonance imaging Prostate Imaging Reporting and Data System and prostate-specific membrane antigen–positron emis sion tomography/computed tomography PRIMARY score in a composite (P) score for more accurate diagnosis of clinically significant prostate cancer. J Urol. 2024;212(2):299-309. doi:10.1097/JU.0000000000004010
Study Need and Importance
The diagnosis of prostate cancer has evolved with the widespread adoption of multiparametric MRI, improving both diagnostic accuracy and reducing the number of biopsies required. The addition of prostate-specific membrane antigen (PSMA)–positron emission tomography (PET) to multiparametric MRI prior to prostate biopsy further improved diagnostic accuracy for clinically significant prostate cancer in men being considered for a prostate biopsy in recent trials. However, there is currently no framework to report a PSMA-PET in the diagnostic setting in conjunction with the MRI findings. This study developed a reporting framework that incorporates both the MRI Prostate Imaging Reporting and Data System (PI-RADS) and PRIMARY (PSMA-PET/CT) score, in the clinical situation where a PSMA-PET is undertaken prior to prostate biopsy.
What We Found
The study found that if the PRIMARY score and MRI PI-RADS score were reported together using the framework developed (P score), the accuracy for diagnosing clinically significant malignancy was higher than reporting either MRI or PSMA-PET findings in isolation (P score area under the receiver operating characteristic curve 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; Figure). P score sensitivity and negative predictive value for International Society of Urological Pathology 3 malignancy were 99% and 98%, respectively, compared to 94% and 92% for MRI, and 92% and 90% for PRIMARY score.
Limitations
While the P score development dataset was prospective, the validation dataset was retrospective with a high proportion of patients with subsequent malignancy on prostate biopsy. This limits applicability of the data in low prevalence screening clinical situations.
Interpretation for Patient Care
If a PSMA-PET is undertaken prior to prostate biopsy to aid in diagnosis, the P score provides an accurate and easy to use framework for interpretation of both MRI and PSMA-PET findings. This can be used by imagers or treating clinicians to optimize risk assessment.
advertisement
advertisement