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. 2018 Aug 9;13(8):e0201384.
doi: 10.1371/journal.pone.0201384. eCollection 2018.

Optimizing patient's selection for prostate biopsy: A single institution experience with multi-parametric MRI and the 4Kscore test for the detection of aggressive prostate cancer

Sanoj Punnen  1 , Bruno Nahar  1 , Nachiketh Soodana-Prakash  1 , Tulay Koru-Sengul  2 , Radka Stoyanova  3 , Alan Pollack  3 , Bruce Kava  1 , Mark L Gonzalgo  1 , Chad R Ritch  1 , Dipen J Parekh  1
Affiliations

Optimizing patient's selection for prostate biopsy: A single institution experience with multi-parametric MRI and the 4Kscore test for the detection of aggressive prostate cancer

Sanoj Punnen et al. PLoS One. .

Abstract

Objectives: To evaluate the performance of mpMRI and the 4Kscore test together for the detection of significant prostate cancer. Material and methods We selected a consecutive series of men who were referred for evaluation of prostate cancer at an academic institution and underwent mpMRI and the 4Kscore test. The primary outcome was the presence of Gleason 7 or higher cancer on biopsy of the prostate. We used logistic regression and Decision Curve Analysis to report the discrimination and clinical utility of using mpMRI and the 4Kscore test for prostate cancer detection. We modeled the probability of harboring a Gleason 7 or higher prostate cancer based on the 4Kscore test and mpMRI findings. Finally, we examined various combinations and sequences of mpMRI and the 4Kscore test and assessed the impact on biopsies avoided and cancers missed.

Results: Among 300 men who underwent a 4Kscore test and mpMRI, 149 (49%) underwent a biopsy. Among those, 73 (49%) had cancer, and 49 (33%) had Gleason 7 cancer. The area under the curve (AUC) for using the 4Kscore test and mpMRI together 0.82 (0.75-0.89) was superior to using the 4Kscore 0.70 (0.62-0.79) or mpMRI 0.74 (0.66-0.81) individually (p = 0.001). Similarly, decision analysis revealed the highest net benefit was achieved using both tests.

Conclusions: The 4Kscore test and mpMRI results provide independent, but complementary, information that enhances the prediction of higher-grade prostate cancer and improves patient's selection for a prostate biopsy. Prospective trials are required to confirm these findings.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Scatter plot of the 4Kscore by PIRADS and biopsy results among 300 men who had a 4K score and a MRI for evaluation of prostate cancer.
Fig 2
Fig 2. Probability of Gleason 7 cancer based on the 4Kscore and mpMRI findings among the 149 men who had mpMRI and 4Kscore and underwent biopsy of the prostate.
It appears that the likelihood of Gleason 7 cancer is predicted best by the mpMRI, and the 4Kscore provides a more granular assessment of risk, within each mpMRI category.
Fig 3
Fig 3. Decision curve analysis comparing clinical utility of 4Kscore, mpMRI and both 4Kscore and mpMRI for detecting clinically relevant cancer.
The curve with the highest net benefit at each threshold probability is the strategy that has the best clinical utility for deciding on the need for a biopsy of the prostate.
See this image and copyright information in PMC

Comment in

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