MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance.
Koo, Brendan C
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Caglic, I., Sushentsev, N., Gnanapragasam, V., Sala, E., Shaida, N., Koo, B. C., Kozlov, V., et al. (2021). MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance.. European radiology, 31 (5), 2696-2705. https://doi.org/10.1007/s00330-020-07336-0
Objectives: To assess the predictive value and correlation to pathological progression of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system in the follow-up of prostate cancer (PCa) patients on active surveillance (AS). Methods: A total of 295 men enrolled on an AS programme between 2011-2018 were included. A baseline mpMRI was performed at AS entry to guide biopsy. The follow-up mpMRI studies were reported by two sub-specialist uro-radiologists with 10 and 13 years of experience. PRECISE scores were dichotomized at the cut-off value of 4 and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Diagnostic performance was further quantified by using area under the receiver operating curve (AUC) which was based on the results of targeted MRI-US fusion biopsy. Univariate analysis using Cox regression was performed to assess which baseline clinical and mpMRI parameters were related to disease progression on AS. Results: Progression rate of the cohort was 13.9% (41/295) over a median follow-up of 52 months. With a cutoff value of category ≥4, the PRECISE scoring system showed sensitivity, specificity, PPV and NPV for predicting progression on AS of 0.76, 0.89, 0.52 and 0.96, respectively. The AUC was 0.82 (95% CI: 0.74-0.90). PSA-density (PSA-D), Likert lesion score and index lesion size were the only significant baseline predictors of progression (each p<0.05). Conclusion: PRECISE scoring system showed good overall performance and the high NPV may help limit the number of follow-up biopsies required in patients on AS.
Humans, Prostatic Neoplasms, Magnetic Resonance Imaging, Male, Watchful Waiting, Image-Guided Biopsy, Multiparametric Magnetic Resonance Imaging
The authors acknowledge research support from Cancer Research UK, National Institute of Health Research Cambridge Biomedical Research Centre, Cancer Research UK and the Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester and the Cambridge Experimental Cancer Medicine Centre.
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External DOI: https://doi.org/10.1007/s00330-020-07336-0
This record's URL: https://www.repository.cam.ac.uk/handle/1810/308664
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