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PD15-11 SHOULD WE STILL BIOPSY NEGATIVE MP-MRIS?
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
discrimination and calibration of the nomogram were prospectively analyzed in 404 men. RESULTS: Overall, PC occurred in 732 (63%) and sPC in 560 (48%) men. In the trainings set, 50% of men harbored PC and 78% of them sPC. In multivariate analysis, PSA, PSA-density, Likert score and ERSPC RC4 (each p<0.001) were significant predictors of sPC and used for the prediction model. In ROC analysis, Area under the curve (AUC) was highest for the novel nomogram (0.82), compared to 0.74 for ERSPC RC4 and 0.76 for Likert scoring. Based on the 0.08 benefit of the nomogram, 404 men were enrolled as prospective validation sample. In that subgroup, accuracy of the nomogram was best (0.79), compared to Likert scoring (0.78) and ERSPC RC4 (0.60). Calibration was analyzed using a calibration plot, demonstrating a good slope (0.94). However, the plot demonstrates slight overestimation of the prediction model. CONCLUSIONS: We provide a new prostate cancer prediction model. This model incorporates both ERSPC RC4 and mpMRI data. Compared to clinical and MRI parameters alone, the model provides significantly more reliable non-invasive risk prediction of sPC. Thus, it can help to avoid unnecessary prostate biopsies. Source of Funding: None
PD15-11 SHOULD WE STILL BIOPSY NEGATIVE MP-MRIS? Amanda Lu, Cayce Nawaf, James Rosoff, Jeffrey Weinreb, Peter Humphrey, Angelique Levi, Steffen Huber, Preston Sprenkle*, New Haven, CT INTRODUCTION AND OBJECTIVES: Increased lesion suspicion score on MRI is known to be associated with increased grade of prostate cancer. However, the negative predictive value (NPV) of MRI is still being investigated. To determine the NPV of mpMRI, we evaluated the frequency of prostate cancer (CaP) detection by 12-core template mapping biopsy (Mbx) in men whose mpMRI showed no suspicious regions. METHODS: 374 men undergoing MRI-US fusion biopsy from 12/2012 to 06/2015 were enrolled in an IRB-approved database and met inclusion criteria for this study. The mpMRI sequences T2weighted, diffusion-weighted imaging, and dynamic contrast enhancement were used to identify and classify targets as low, medium, and high suspicion. Men with negative mpMRI received a template 12-core template mapping biopsy. Only patients with complete mpMRI sequences were included. RESULTS: 53 men with a negative MRI were identified (mean age¼63.5 years, PSA¼7.53 ng/mL, mean prostate volume¼67.2 mL). The NPV of negative MRI was 64.2% for any cancer and 96.2% for clinically significant cancer (Gleason7). Men on active surveillance had the highest CDR 56.3%, compared to 38.9% for biopsy-naive men, and 15.8% for men with prior negative biopsy (Figure 1). Clinically significant CaP was found in two patients: Gleason 4+3 in a patient on Active Surveillance, and 4+4 in a biopsy naïve patient. CONCLUSIONS: Negative MRI has a high NPV (96%) for clinically significant CaP found in 12-core template mapping biopsy. If we did not biopsy mpMRI negative men, we would have missed 16 patients with Gleason 6 and 2 patients with Gleason 7. Clinicians can use this information in patient counseling to discuss the likelihood of detecting significant cancer, though these findings should be reproduced widely before a negative MRI is used to recommend against biopsy.
e393
Source of Funding: NIH-National Institute of Diabetes and Digestive and Kidney Diseases
PD15-12 CORRELATION BETWEEN MULTIPARAMETRIC MRI FINDINGS AND RADICAL PROSTATECTOMY SPECIMENS IN 162 PATIENTS Sean Huang*, Sarah Mann, Richard O’Sullivan, Andrew Ryan, Adam Landau, Ross Snow, Uri Hanegbi, Daniel Moon, Mark Frydenberg, Jeremy Grummet, Melbourne, Australia INTRODUCTION AND OBJECTIVES: Multiparametric (mp) MRI has the potential to revolutionise prostate cancer diagnosis. This study aims to determine the correlation between mpMRI of the prostate and radical prostatectomy specimens with respect to the location, stage and grade of prostate cancer. METHODS: A prospective, ethics approved database of all men undergoing mpMRI for suspicion of prostate cancer in our group practice was kept. Of these men, all who had a 3-D summary diagram including PIRADS score for each mpMRI and who then underwent radical prostatectomy were assessed. Volumetric studies were performed for all prostatectomy specimens and compared to each corresponding mpMRI 3-D summary diagram. RESULTS: 162 patients were identified with mpMRI performed prior to biopsy and subsequent radical prostatectomy between November 2013 and August 2015. Mean age was 62.8 years (range 4177) and mean PSA 7.8 (range 1.3 e 45). 105 (64.8%) patients had their mpMRI for initial work-up of prostate cancer, 42 (25.9%) for active surveillance and 15 (9.3%) had previous negative biopsies. Our study revealed an index tumour sensitivity of 0.802 (95%CI 0.73-0.86) with 130 index tumours identified by initial mpMRI correlating with prostatectomy specimens. Positive predictive values were 54.5% for PIRADS 3, 87.8% for PIRADS 4 and 93.5% for PIRADS 5 index lesions identified on mpMRI. Of the 80 patients with pT3 cancers, 54 (67.5%) were reported to have no or low suspicion of extra-prostatic disease on mpMRI. 148 patients (91.4%) had multifocal disease with additional non-index tumours identified. In patients with non-index tumours, only 1 of 3 (33%) with Gleason 4+3¼7 was missed by mpMRI whereas 69.4% (59 of 85) of those with Gleason score 3+4¼7 were missed by mpMRI. 95.0% (57/ 60) with greatest score Gleason 3+3¼6 non-index lesions were not detected by mpMRI. CONCLUSIONS: Our findings show an impressive correlation between mpMRI and radical prostatectomy specimens for index lesions and higher grade non-index lesions, supporting mpMRI’s increasing utility in imaging of localised prostate cancer. However, mpMRI misses a significant number of clinically significant tumours, such that the standard of care including systematic biopsy of the prostate should not be withheld. Similarly, given the substantial miss rate of non-index Gleason 3+4¼7 tumours, great caution should be used if considering focal therapy, and ongoing active surveillance of non-index tumours is mandatory. The role of mpMRI in the diagnosis of prostate cancer is evolving rapidly and requires ongoing thorough analysis for quality assurance. Source of Funding: none
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
discrimination and calibration of the nomogram were prospectively analyzed in 404 men. RESULTS: Overall, PC occurred in 732 (63%) and sPC in 560 (48%) men. In the trainings set, 50% of men harbored PC and 78% of them sPC. In multivariate analysis, PSA, PSA-density, Likert score and ERSPC RC4 (each p<0.001) were significant predictors of sPC and used for the prediction model. In ROC analysis, Area under the curve (AUC) was highest for the novel nomogram (0.82), compared to 0.74 for ERSPC RC4 and 0.76 for Likert scoring. Based on the 0.08 benefit of the nomogram, 404 men were enrolled as prospective validation sample. In that subgroup, accuracy of the nomogram was best (0.79), compared to Likert scoring (0.78) and ERSPC RC4 (0.60). Calibration was analyzed using a calibration plot, demonstrating a good slope (0.94). However, the plot demonstrates slight overestimation of the prediction model. CONCLUSIONS: We provide a new prostate cancer prediction model. This model incorporates both ERSPC RC4 and mpMRI data. Compared to clinical and MRI parameters alone, the model provides significantly more reliable non-invasive risk prediction of sPC. Thus, it can help to avoid unnecessary prostate biopsies. Source of Funding: None
PD15-11 SHOULD WE STILL BIOPSY NEGATIVE MP-MRIS? Amanda Lu, Cayce Nawaf, James Rosoff, Jeffrey Weinreb, Peter Humphrey, Angelique Levi, Steffen Huber, Preston Sprenkle*, New Haven, CT INTRODUCTION AND OBJECTIVES: Increased lesion suspicion score on MRI is known to be associated with increased grade of prostate cancer. However, the negative predictive value (NPV) of MRI is still being investigated. To determine the NPV of mpMRI, we evaluated the frequency of prostate cancer (CaP) detection by 12-core template mapping biopsy (Mbx) in men whose mpMRI showed no suspicious regions. METHODS: 374 men undergoing MRI-US fusion biopsy from 12/2012 to 06/2015 were enrolled in an IRB-approved database and met inclusion criteria for this study. The mpMRI sequences T2weighted, diffusion-weighted imaging, and dynamic contrast enhancement were used to identify and classify targets as low, medium, and high suspicion. Men with negative mpMRI received a template 12-core template mapping biopsy. Only patients with complete mpMRI sequences were included. RESULTS: 53 men with a negative MRI were identified (mean age¼63.5 years, PSA¼7.53 ng/mL, mean prostate volume¼67.2 mL). The NPV of negative MRI was 64.2% for any cancer and 96.2% for clinically significant cancer (Gleason7). Men on active surveillance had the highest CDR 56.3%, compared to 38.9% for biopsy-naive men, and 15.8% for men with prior negative biopsy (Figure 1). Clinically significant CaP was found in two patients: Gleason 4+3 in a patient on Active Surveillance, and 4+4 in a biopsy naïve patient. CONCLUSIONS: Negative MRI has a high NPV (96%) for clinically significant CaP found in 12-core template mapping biopsy. If we did not biopsy mpMRI negative men, we would have missed 16 patients with Gleason 6 and 2 patients with Gleason 7. Clinicians can use this information in patient counseling to discuss the likelihood of detecting significant cancer, though these findings should be reproduced widely before a negative MRI is used to recommend against biopsy.
e393
Source of Funding: NIH-National Institute of Diabetes and Digestive and Kidney Diseases
PD15-12 CORRELATION BETWEEN MULTIPARAMETRIC MRI FINDINGS AND RADICAL PROSTATECTOMY SPECIMENS IN 162 PATIENTS Sean Huang*, Sarah Mann, Richard O’Sullivan, Andrew Ryan, Adam Landau, Ross Snow, Uri Hanegbi, Daniel Moon, Mark Frydenberg, Jeremy Grummet, Melbourne, Australia INTRODUCTION AND OBJECTIVES: Multiparametric (mp) MRI has the potential to revolutionise prostate cancer diagnosis. This study aims to determine the correlation between mpMRI of the prostate and radical prostatectomy specimens with respect to the location, stage and grade of prostate cancer. METHODS: A prospective, ethics approved database of all men undergoing mpMRI for suspicion of prostate cancer in our group practice was kept. Of these men, all who had a 3-D summary diagram including PIRADS score for each mpMRI and who then underwent radical prostatectomy were assessed. Volumetric studies were performed for all prostatectomy specimens and compared to each corresponding mpMRI 3-D summary diagram. RESULTS: 162 patients were identified with mpMRI performed prior to biopsy and subsequent radical prostatectomy between November 2013 and August 2015. Mean age was 62.8 years (range 4177) and mean PSA 7.8 (range 1.3 e 45). 105 (64.8%) patients had their mpMRI for initial work-up of prostate cancer, 42 (25.9%) for active surveillance and 15 (9.3%) had previous negative biopsies. Our study revealed an index tumour sensitivity of 0.802 (95%CI 0.73-0.86) with 130 index tumours identified by initial mpMRI correlating with prostatectomy specimens. Positive predictive values were 54.5% for PIRADS 3, 87.8% for PIRADS 4 and 93.5% for PIRADS 5 index lesions identified on mpMRI. Of the 80 patients with pT3 cancers, 54 (67.5%) were reported to have no or low suspicion of extra-prostatic disease on mpMRI. 148 patients (91.4%) had multifocal disease with additional non-index tumours identified. In patients with non-index tumours, only 1 of 3 (33%) with Gleason 4+3¼7 was missed by mpMRI whereas 69.4% (59 of 85) of those with Gleason score 3+4¼7 were missed by mpMRI. 95.0% (57/ 60) with greatest score Gleason 3+3¼6 non-index lesions were not detected by mpMRI. CONCLUSIONS: Our findings show an impressive correlation between mpMRI and radical prostatectomy specimens for index lesions and higher grade non-index lesions, supporting mpMRI’s increasing utility in imaging of localised prostate cancer. However, mpMRI misses a significant number of clinically significant tumours, such that the standard of care including systematic biopsy of the prostate should not be withheld. Similarly, given the substantial miss rate of non-index Gleason 3+4¼7 tumours, great caution should be used if considering focal therapy, and ongoing active surveillance of non-index tumours is mandatory. The role of mpMRI in the diagnosis of prostate cancer is evolving rapidly and requires ongoing thorough analysis for quality assurance. Source of Funding: none