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. 2022 May 11;14(10):2374.
doi: 10.3390/cancers14102374.

Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy

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

Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy

Juan Morote et al. Cancers (Basel). .

Abstract

This study is a head-to-head comparison between mPSAD and MRI-PMbdex. The MRI-PMbdex was created from 2432 men with suspected PCa; this cohort comprised the development and external validation cohorts of the Barcelona MRI predictive model. Pre-biopsy 3-Tesla multiparametric MRI (mpMRI) and 2 to 4-core transrectal ultrasound (TRUS)-guided biopsies for suspicious lesions and/or 12-core TRUS systematic biopsies were scheduled. Clinically significant PCa (csPCa), defined as Gleason-based Grade Group 2 or higher, was detected in 934 men (38.4%). The area under the curve was 0.893 (95% confidence interval [CI]: 0.880−0.906) for MRI-PMbdex and 0.764 (95% CI: 0.774−0.783) for mPSAD, with p < 0.001. MRI-PMbdex showed net benefit over biopsy in all men when the probability of csPCa was greater than 2%, while mPSAD did the same when the probability of csPCa was greater than 18%. Thresholds of 13.5% for MRI-PMbdex and 0.628 ng/mL2 for mPSAD had 95% sensitivity for csPCa and presented 51.1% specificity for MRI-PMbdex and 19.6% specificity for mPSAD, with p < 0.001. MRI-PMbdex exhibited net benefit over mPSAD in men with prostate imaging report and data system (PI-RADS) <4, while neither exhibited any benefit in men with PI-RADS 5. Hence, we can conclude that MRI-PMbdex is more accurate than mPSAD for the proper selection of candidates for prostate biopsy among men with suspected PCa, with the exception of men with a PI-RAD S 5 score, for whom neither tool exhibited clinical guidance to determine the need for biopsy.

Keywords: clinically significant prostate cancer; predictive model; prostate-specific antigen density.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa (A). The DCAs show the net benefit of mPSAD and MRI-PMbdex compared to performing biopsies on all men according to the csPCa probability threshold (B).
Figure 1
Figure 1
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa (A). The DCAs show the net benefit of mPSAD and MRI-PMbdex compared to performing biopsies on all men according to the csPCa probability threshold (B).
Figure 2
Figure 2
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS < 3 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
Figure 2
Figure 2
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS < 3 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
Figure 3
Figure 3
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS 3 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
Figure 3
Figure 3
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS 3 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
Figure 4
Figure 4
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS 4 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
Figure 4
Figure 4
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS 4 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
Figure 5
Figure 5
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS 5 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
Figure 5
Figure 5
The ROC curves and AUCs show the efficacy of mPSAD (PSAD in the graphic) and MRI-PMbdex (model in the graphic) in detecting csPCa in men with PI-RADS 5 (A). The DCAs showing the net benefit of mPSAD and MRI-PMbdex over performing biopsies on all men according to the csPCa probability threshold (B).
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