Comparison of risk-calculator and MRI and consecutive pathways as upfront stratification for prostate biopsy
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ORIGINAL ARTICLE
Comparison of risk‑calculator and MRI and consecutive pathways as upfront stratification for prostate biopsy Daan J. Reesink1 · Melline G. M. Schilham1 · Erik J. R. J. van der Hoeven2 · Ivo G. Schoots3,4 · Harm H. E. van Melick1 · Roderick C. N. van den Bergh1 Received: 23 June 2020 / Accepted: 7 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose In biopsy naïve men suspected for prostate cancer (PCa), it is uncertain how a risk-calculator and bi-parametric (bp) MRI should be combined to decide on prostate biopsy, balancing cancer detection rates and diagnostic burden. Methods Prospective, single centre cohort study (August 2018–April 2019). All patients referred with serum PSA ≥ 3 ng/ ml or abnormal digital rectal examination received bpMRI and risk for PCa was calculated using the ERSPC risk-calculator. Men with either PI-RADS ≥ 3 or calculator risk-score > 20% were recommended to undergo systematic biopsy (SB) and targeted biopsy (TB) of any visible lesion (reference pathway). Eight different derived diagnostic pathways were compared to the reference pathway regarding cancer detection, number of biopsies and bpMRIs performed. Results Of 496 patients; 233 (47%) had a risk-calculator score of > 20%; 201 (41%) had PI-RADS score ≥ 3. The reference pathway detected PCa in 32.1%, clinically significant (cs) PCa in 19.4%, with 41% avoided biopsies, but 0% avoided bpMRI. Stratification with only risk-calculator: 76% csPCa diagnosed, 53% avoided biopsies and 100% avoided bpMRI. Stratification with only bpMRI: 97% csPCa diagnosed, 59% avoided biopsies, but 0% avoided bpMRI. A pathway with risk-calculator first, followed only with bpMRI when high-risk: 81% csPCa diagnosed, 72% avoided biopsies and 53% avoided bpMRI. Conclusion Upfront bpMRI as a risk stratification tool outperforms risk-calculator in detecting significant disease. Applying the risk-calculator first to decide on performing an MRI, avoids 1 out of 2 MRIs, but up to 1 out of 5 significant cancers are missed. Keywords Prostate cancer · Prostate cancer screening · Prostate MRI · Prostate biopsy · Risk calculator · Risk-prediction tool
Daan J. Reesink and Melline G.M. Schilham shared first authorship. Harm H.E. van Melick and Roderick C. N. van den Bergh shared senior authorship. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03488-2) contains supplementary material, which is available to authorized users. * Daan J. Reesink [email protected]
Department of Urology, St. Antonius Hospital Utrecht/ Nieuwegein, Koekoekslaan 1, Utrecht 3435CM, The Netherlands
2
Department of Radiology, St. Antonius Hospital Utrecht/Nieuwegein, Utrecht, The Netherlands
Introduction Systematic prostate biopsy in men with suspicion of prostate cancer (PCa), based on elevated levels of serum prostatespecific antigen (PSA) and/or digital rectal examination (DRE), may lead to unnecessary biopsies, overdetection of clinically insignificant (ci
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