Development and External Validation of a Prediction Model to Identify Candidates for Prostate Biopsy
23 February 2021
Purpose: Prostate biopsies are associated with infectious complications and approximately 80% are either benign or clinically insignificant prostate cancer. Our aim is to develop and independently validate prediction model to avoid unnecessary prostate biopsies by predicting clinically significant prostate cancer (csPCa)
Materials and Methods: Retrospective analysis of single-center cohort (Mount Sinai Hospital, NY) of 1632 men who underwent systematic or combined systematic and Magnetic Resonance Imaging (MRI)/ultrasound fusion targeted prostate biopsy between 2014-2020. External cohort (University of Miami) included 622 men that underwent biopsy. Outcome for predicting csPCa was defined as International Society of Urologic Pathology (ISUP) Gleason grade ³ 2 on biopsy. Multivariable logistic regression analysis was performed to build nomogram using coefficients of logit function. Nomogram validation was performed in external cohort by plotting receiver operating characteristics (ROC). We also plotted decision curve analysis (DCA) and compared nomogram-predicted probabilities with actual rates of csPCa probabilities in external cohort.
Results: Of 1632 men, 43% showed csPCa on biopsy. PSA density, prior negative biopsy, and Prostate Imaging and Reporting Data System (PI-RADS) scores 3, 4, and 5 were significant predictors for csPCa. ROC for prediction of csPCa was 0.88 in external cohort. There was agreement between predicted and actual rate of csPCa in external cohort. DCA demonstrated net benefit using the model. Using the prediction model at threshold of 30, 35% of biopsies and 46% of diagnosed indolent PCa could be avoided, while missing 5% of csPCa.
Conclusion: Using our prediction model can help reduce unnecessary prostate biopsies with minimal impact on csPCa detection rates.
- prostate cancer, biopsy, prediction model, prostate cancer prognostic tool, multiparametric MRI
How to Cite
2. Voigt JD, Zappala SM, Vaughan ED, Wein AJ. The Kallikrein Panel for prostate cancer screening: Its economic impact. The Prostate. 2014;74(3):250-259.
3. Halpern JA, Shoag JE, Artis AS, et al. National Trends in Prostate Biopsy and Radical
Prostatectomy Volumes Following the US Preventive Services Task Force Guidelines Against Prostate-Specific Antigen Screening. JAMA Surg. 2017;152(2):192-198.
4. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011;186(5):1830-1834.
5. Parekh DJ, Punnen S, Sjoberg DD, et al. A multi-institutional prospective trial in the USA confirms that the 4Kscore accurately identifies men with high-grade prostate cancer. Eur Urol. 2015;68(3):464-470.
6. Wagenlehner FM, van Oostrum E, Tenke P, et al. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol. 2013;63(3):521-527.
7. Naji L, Randhawa H, Sohani Z, et al. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med. 2018;16(2):149-154.
8. Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. New England Journal of Medicine. 2018;378(19):1767-1777.
9. Oishi M, Shin T, Ohe C, et al. Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer? J Urol. 2019;201(2):268-276.
10. Delongchamps NB, Portalez D, Bruguière E, et al. Are Magnetic Resonance Imaging-Transrectal Ultrasound Guided Targeted Biopsies Noninferior to Transrectal Ultrasound Guided Systematic Biopsies for the Detection of Prostate Cancer? J Urol. 2016;196(4):1069-1075.
11. Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS Prostate Imaging – Reporting and Data System: 2015, Version 2. European Urology. 2016;69(1):16-40.
12. Borghesi M, Ahmed H, Nam R, et al. Complications After Systematic, Random, and Image-guided Prostate Biopsy. Eur Urol. 2017;71(3):353-365.
13. Aly M, Dyrdak R, Nordström T, et al. Rapid increase in multidrug-resistant enteric bacilli blood stream infection after prostate biopsy—A 10-year population-based cohort study. The Prostate. 2015;75(9):947-956.
14. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027-2035.
15. Lee SM, Liyanage SH, Wulaningsih W, et al. Toward an MRI-based nomogram for the prediction of transperineal prostate biopsy outcome: A physician and patient decision tool. Urol Oncol. 2017;35(11):664.e611-664.e618.
16. van Leeuwen PJ, Hayen A, Thompson JE, et al. A multiparametric magnetic resonance imaging-based risk model to determine the risk of significant prostate cancer prior to biopsy. BJU Int. 2017;120(6):774-781.
17. Fütterer JJ, Briganti A, De Visschere P, et al. Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature. Eur Urol. 2015;68(6):1045-1053.
18. Nordström T, Akre O, Aly M, Grönberg H, Eklund M. Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer. Prostate Cancer Prostatic Dis. 2018;21(1):57-63.
19. J.G. Rivas, M. Alvarez-Maestro, M. Czarniecki, S. Czarniecki, M.R. Socarras, S. Loeb. Negative biopsies with rising prostate-specific antigen. What to do? EMJ Urol, 5 (2017), pp. 76-82
20. Thomas JA, 2nd, Gerber L, Moreira DM, et al. Prostate cancer risk in men with prostate and breast cancer family history: results from the REDUCE study (R1). J Intern Med. 2012;272(1):85-92.
- Abstract Viewed: 0 times
- Just Accepted/6852 Downloaded: 0 times