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Could Magnetic Resonance Imaging Help to Identify the Presence of Prostate Cancer Before Initial Biopsy? The Development of Nomogram Predicting the Outcomes of Prostate Biopsy in the Chinese Population

Annals of Surgical Oncology volume 23, pages 4284–4292 (2016)Cite this article

Abstract

Purpose

This study was designed to investigate the effectiveness of magnetic resonance imaging (MRI) in diagnosing prostate cancer (PCa) and high-grade prostate cancer (HGPCa) before transrectal ultrasound (TRUS)-guided biopsy.

Methods

The clinical data of 894 patients who received TRUS-guided biopsy and prior MRI test from a large Chinese center was reviewed. Based on Prostate Imaging Reporting and Data System (PI-RADS) scoring, all MRIs were re-reviewed and assigned as Grade 0–2 (PI-RADS 1–2; PI-RADS 3; PI-RADS 4–5). We constructed two models both in predicting PCa and HGPCa (Gleason score ≥ 4 + 3): Model 1 with MRI and Model 2 without MRI. Other clinical factors include age, digital rectal examination, PSA, free-PSA, volume, and TRUS.

Results

PCa and HGPCa were present in 434 (48.5 %) and 218 (24.4 %) patients. An MRI Grade 0, 1, and 2 were assigned in 324 (36.2 %), 193 (21.6 %) and 377 (42.2 %) patients, which was associated with the presence of PCa (p < 0.001) and HGPCa (p < 0.001). Particularly in patients aged ≤55 years, the assignment of MRI Grade 0 was correlated with extremely low rate of PCa (1/27) and no HGPCa. The c-statistic of Model 1 and Model 2 for predicting PCa was 0.875 and 0.841 (Z = 4.2302, p < 0.001), whereas for predicting HGPCa was 0.872 and 0.850 (Z = 3.265, p = 0.001). Model 1 exhibited higher sensitivity and specificity at same cutoffs, and decision-curve analysis also suggested the favorable clinical utility of Model 1.

Conclusions

Prostate MRI before biopsy could predict the presence of PCa and HGPCa, especially in younger patients. The incorporation of MRI in nomograms could increase predictive accuracy.

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Acknowledgment

This work was supported by Grants from the National Natural Science Foundation of China (81372746), and the Science and technology achievements and the appropriate technology promotion projects of Beijing Municipal Commission of Health and Family Planning (TG-2014-13). The authors thank the entire staff of the Department of Urology and Department or Radiology, Peking University First Hospital.

Disclosure

The authors have declared that no competing interests exist.

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    Affiliations

    1. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

      Dong Fang MD, Da Ren MD, Wei Yu MD, PhD, Xuesong Li MD, PhD, Wenshi Yin MD, Xiaoteng Yu MD, Kunlin Yang MD, Pei Liu MD, Gangzhi Shan MD, PhD, Shuqing Li MD, PhD, Qun He MD, PhD, Zhongcheng Xin MD, PhD & Liqun Zhou MD, PhD

    2. Department of Radiology, Peking University First Hospital, Beijing, China

      Chenglin Zhao MD, Rui Wang MD, Huihui Wang MD & Xiaoying Wang MD, PhD

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    Correspondence to Zhongcheng Xin MD, PhD or Liqun Zhou MD, PhD.

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    Dong Fang and Chenglin Zhao have contributed equally.

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    Fang, D., Zhao, C., Ren, D. et al. Could Magnetic Resonance Imaging Help to Identify the Presence of Prostate Cancer Before Initial Biopsy? The Development of Nomogram Predicting the Outcomes of Prostate Biopsy in the Chinese Population. Ann Surg Oncol 23, 4284–4292 (2016). https://doi.org/10.1245/s10434-016-5438-2

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    • DOI: https://doi.org/10.1245/s10434-016-5438-2

    Keywords

    • Magnetic Resonance Imaging
    • Prostatitis
    • Prostate Biopsy
    • Prostate Volume
    • Digital Rectal Examination