title: Clinical implications of a multiparametric magnetic resonance imaging based nomogram applied to prostate cancer active surveillance.
abstract: OBJECTIVE
  Multiparametric magnetic resonance imaging may be beneficial in the search for rational ways to decrease prostate cancer intervention in patients on active surveillance. We applied a previously generated nomogram based on multiparametric magnetic resonance imaging to predict active surveillance eligibility based on repeat biopsy outcomes.
  
  
  METHODS
  We reviewed the records of 85 patients who met active surveillance criteria at study entry based on initial biopsy and who then underwent 3.0 Tesla multiparametric magnetic resonance imaging with subsequent magnetic resonance imaging/ultrasound fusion guided prostate biopsy between 2007 and 2012. We assessed the accuracy of a previously published nomogram in patients on active surveillance before confirmatory biopsy. For each cutoff we determined the number of biopsies avoided (ie reliance on magnetic resonance imaging alone without rebiopsy) over the full range of nomogram cutoffs.
  
  
  RESULTS
  We assessed the performance of the multiparametric magnetic resonance imaging active surveillance nomogram based on a decision to perform biopsy at various nomogram generated probabilities. Based on cutoff probabilities of 19% to 32% on the nomogram the number of patients who could be spared repeat biopsy was 27% to 68% of the active surveillance cohort. The sensitivity of the test in this interval was 97% to 71% and negative predictive value was 91% to 81%.
  
  
  CONCLUSIONS
  Multiparametric magnetic resonance imaging based nomograms may reasonably decrease the number of repeat biopsies in patients on active surveillance by as much as 68%. Analysis over the full range of nomogram generated probabilities allows patient and caregiver preference based decision making on the risk assumed for the benefit of fewer repeat biopsies.
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: M Minhaj
authors: MM
authors: Siddiqui
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Hong
authors: H
authors: Truong
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Soroush
authors: S
authors: Rais-Bahrami
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Lambros
authors: L
authors: Stamatakis
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Jennifer
authors: J
authors: Logan
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Annerleim
authors: A
authors: Walton-Diaz
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Baris
authors: B
authors: Turkbey
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Peter L
authors: PL
authors: Choyke
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Bradford J
authors: BJ
authors: Wood
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
authors: Richard M
authors: RM
authors: Simon
authors: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland. Electronic address: pintop@mail.nih.gov.
authors: Peter A
authors: PA
authors: Pinto
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D057832:Watchful Waiting
keywords: biopsy; magnetic resonance imaging; nomograms; prostatic neoplasms; risk
references: J Urol. 2003 Nov;170(5):1792-7
references: 14532778
references: Cancer. 2007 Jun 15;109(12):2432-8
references: 17497649
references: J Urol. 2007 Jun;177(6):2106-31
references: 17509297
references: Cancer. 2007 Nov 15;110(10):2218-21
references: 17893906
references: Cancer. 2007 Dec 1;110(11):2441-7
references: 17932909
references: Cancer. 2008 Jan 1;112(1):69-74
references: 18000803
references: JAMA. 2009 Sep 16;302(11):1202-9
references: 19755699
references: Radiology. 2010 Apr;255(1):89-99
references: 20308447
references: BJU Int. 2011 Jan;107(1):53-7
references: 20590543
references: J Clin Oncol. 2011 Jun 1;29(16):2185-90
references: 21464416
references: Int Urol Nephrol. 2012 Apr;44(2):459-70
references: 21706297
references: Eur Urol. 2011 Nov;60(5):920-30
references: 21741762
references: J Urol. 2011 Oct;186(4):1281-5
references: 21849184
references: BJU Int. 2012 May;109(9):1315-22
references: 21933336
references: J Urol. 2011 Nov;186(5):1811-7
references: 21944097
references: Eur Urol. 2012 May;61(5):1019-24
references: 22336380
references: BJU Int. 2012 Dec;110(11):1642-7
references: 22973825
references: Br J Cancer. 2012 Oct 23;107(9):1467-73
references: 23037714
references: J Urol. 2013 Jun;189(6):2092-8
references: 23219546
references: Radiology. 2013 Jul;268(1):144-52
references: 23468576
references: BJU Int. 2013 Jul;112(1):39-44
references: 23551868
references: J Urol. 2013 Nov;190(5):1721-1727
references: 23727310
references: Eur Urol. 2013 Nov;64(5):713-719
references: 23787357
references: J Urol. 2013 Dec;190(6):2020-2025
references: 23792130
references: Cancer. 2013 Nov 15;119(22):3992-4002
references: 24006289
references: JAMA. 1997 May 14;277(18):1445-51
references: 9145716