title: Validity of the Cancer of the Prostate Risk Assessment Score Derived From Targeted Biopsy: Modeling Evidence From Ultrasound Lesion-Directed Biopsy.
abstract: Our aim was to evaluate the impact of direct, ultrasound lesion-targeted prostate biopsy, alone or in combination with systematic sampling, on prostate cancer risk prediction.
  
  
  
  We reviewed biopsy findings for men with known or clinical suspicion of prostate cancer undergoing direct, ultrasound-targeted biopsy of radiographic lesions with concomitant systematic extended peripheral zone biopsy. We examined the resulting tumor volume estimates, Gleason grade, and Cancer of the Prostate Risk Assessment score generated from each strategy. Resulting multivariate clinical models of adverse surgical pathology-defined as high grade (Gleason pattern, ≥ 4+3) or non-organ-confined disease (≥ pT3a) were compared by the area under the Receiver Operating Characteristic curve.
  
  
  
  A total of 352 patients received ultrasound-targeted biopsy. At diagnosis, the mean age was 63 years, median prostate-specific antigen, 5.7 ng/mL (interquartile range, 4.3-8.2), and median 15 cores (interquartile range, 12-18). The addition of targeted cores to systematic biopsy resulted in reclassification of 52 patients (14.7%) based on Gleason score, 45 (12.8%) by percentage of cores involved > 33%, and 51 (14.5%) by single core positivity > 50%; Cancer of the Prostate Risk Assessment risk category increased in 44 (12.5%). In multivariable logistic regression models of 196 men treated with prostatectomy, the area under the Receiver Operating Characteristic curve for the prediction of adverse pathology generated from targeted (0.754), systematic (0.753), and combined approaches (0.763) were not significantly different (P = .831).
  
  
  
  The validity of clinical risk prediction assessed with a multi-variable instrument was maintained in the setting of lesion-targeted biopsy.
authors: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Department of Urology, Yale University School of Medicine, New Haven, CT. Electronic address: Michael.leapman@yale.edu.
authors: Michael S
authors: MS
authors: Leapman
authors: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
authors: Niloufar
authors: N
authors: Ameli
authors: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
authors: Katsuto
authors: K
authors: Shinohara
authors: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
authors: Hao G
authors: HG
authors: Nguyen
authors: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
authors: Maxwell V
authors: MV
authors: Meng
authors: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
authors: Matthew R
authors: MR
authors: Cooperberg
authors: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
authors: Peter R
authors: PR
authors: Carroll
mesh_terms: D000368:Aged; D019540:Area Under Curve; D055088:Early Detection of Cancer; D006801:Humans; D061705:Image-Guided Biopsy; D007610:Kallikreins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000145:classification* / Q000378:metabolism / Q000473:pathology*; D012044:Regression Analysis; D018570:Risk Assessment; D047368:Tumor Burden; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: CAPRA; Clinical risk; Prostate cancer risk prediction; TRUS; Transrectal ultrasound