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. 2022 Mar 21;14(6):1589.
doi: 10.3390/cancers14061589.

The Barcelona Predictive Model of Clinically Significant Prostate Cancer

Juan Morote  1   2 , Angel Borque-Fernando  3 , Marina Triquell  1   2 , Anna Celma  1   2 , Lucas Regis  1   2 , Manel Escobar  4 , Richard Mast  4 , Inés M de Torres  5   6 , María E Semidey  5   6 , José M Abascal  7 , Carles Sola  7 , Pol Servian  8 , Daniel Salvador  8 , Anna Santamaría  9 , Jacques Planas  1 , Luis M Esteban  10 , Enrique Trilla  1   2
Affiliations

The Barcelona Predictive Model of Clinically Significant Prostate Cancer

Juan Morote et al. Cancers (Basel). .

Abstract

A new and externally validated MRI-PM for csPCa was developed in the metropolitan area of Barcelona, and a web-RC designed with the new option of selecting the csPCa probability threshold. The development cohort comprised 1486 men scheduled to undergo a 3-tesla multiparametric MRI (mpMRI) and guided and/or systematic biopsies in one academic institution of Barcelona. The external validation cohort comprised 946 men in whom the same diagnostic approach was carried out as in the development cohort, in two other academic institutions of the same metropolitan area. CsPCa was detected in 36.9% of men in the development cohort and 40.8% in the external validation cohort (p = 0.054). The area under the curve of mpMRI increased from 0.842 to 0.897 in the developed MRI-PM (p < 0.001), and from 0.743 to 0.858 in the external validation cohort (p < 0.001). A selected 15% threshold avoided 40.1% of prostate biopsies and missed 5.4% of the 36.9% csPCa detected in the development cohort. In men with PI-RADS <3, 4.3% would be biopsied and 32.3% of all existing 4.2% of csPCa would be detected. In men with PI-RADS 3, 62% of prostate biopsies would be avoided and 28% of all existing 12.4% of csPCa would be undetected. In men with PI-RADS 4, 4% of prostate biopsies would be avoided and 0.6% of all existing 43.1% of csPCa would be undetected. In men with PI-RADS 5, 0.6% of prostate biopsies would be avoided and none of the existing 42.0% of csPCa would be undetected. The Barcelona MRI-PM presented good performance on the overall population; however, its clinical usefulness varied regarding the PI-RADS category. The selection of csPCa probability thresholds in the designed RC may facilitate external validation and outperformance of MRI-PMs in specific PI-RADS categories.

Keywords: clinically significant prostate cancer; magnetic resonance imaging; predictive model; risk calculator.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of development cohort creation: inclusion and exclusion criteria.
Figure 2
Figure 2
ROC curves showing the efficiency of MRI and MRI-PM in the development cohort (A). DCAs evaluating the net benefit of MRI and MRI-PM over biopsying all men belonging to the development cohort (B).
Figure 3
Figure 3
Nomogram derived from the developed MRI-PM model of csPCa in prostate biopsies.
Figure 4
Figure 4
CUCs showing the rates of avoided biopsies (red lines) and corresponding missed csPCa (blue lines) regarding the continuous threshold of csPCa probability using MRI-PMs in development cohort (continuous lines) and external validation cohorts (interrupted lines).
Figure 5
Figure 5
(A) ROC curves showing the efficacy of MRI-PM in development cohort and external validation cohort; (B) DCAs analysing the net benefit of MRI-PM in development (red interrupted line) and external validation (blue interrupted line) cohort over biopsying all men (continuous grey line).
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