title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Fang
authors.affiliation: Department of Radiology, Peking University First Hospital, Beijing, China.
authors.forename: Chenglin
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Da
authors.initials: D
authors.lastname: Ren
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Radiology, Peking University First Hospital, Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Radiology, Peking University First Hospital, Beijing, China.
authors.forename: Huihui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Wenshi
authors.initials: W
authors.lastname: Yin
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Xiaoteng
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Kunlin
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Gangzhi
authors.initials: G
authors.lastname: Shan
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Shuqing
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Radiology, Peking University First Hospital, Beijing, China.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China. xinzc@bjmu.edu.cn.
authors.forename: Zhongcheng
authors.initials: Z
authors.lastname: Xin
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China. zhoulqmail@sina.com.
authors.forename: Liqun
authors.initials: L
authors.lastname: Zhou
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002681:China; D051517:Digital Rectal Examination; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D049451:Nomograms; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen