title: Factors predicting prostate cancer upgrading on magnetic resonance imaging-targeted biopsy in an active surveillance population.
abstract: The objective of this study was to create a nomogram model integrating clinical and multiparametric magnetic resonance imaging (MP-MRI)-based variables to predict prostate cancer upgrading in a population of active surveillance (AS) patients.
  
  
  
  Prostate cancer patients on AS who underwent MP-MRI with magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy were identified. Clinical and imaging variables, including the prostate-specific antigen density (PSAD), number of lesions, total lesion volume, total lesion density, Prostate Imaging Reporting and Data System magnetic resonance imaging suspicion score (MRI-SS), and duration between prereferral systematic and MRI/US fusion-guided biopsy sessions, were assessed. Logistic regression modeling was used to assess upgrading on MRI/US fusion-guided biopsy. A predictive model for upgrading was calculated with the significant factors identified.
  
  
  
  Seventy-six patients were analyzed with a mean age of 62.5 years and a median prostate-specific antigen (PSA) level of 5.1 ng/mL. The average duration between prereferral and MRI/US biopsies was 21 months. Twenty patients (26.32%) were upgraded. The PSAD, duration between prereferral and MRI/US biopsies, MRI-SS, and MRI total lesion density were significantly associated with upgrading. A logistic regression model using these factors to predict upgrading on confirmatory MRI/US fusion biopsy had an area under the curve (AUC) of 0.84, whereas the AUC was 0.69 with PSA alone. On the basis of this model, a nomogram was generated, and using a probability cutoff of 22% as an indication of upgrading, it produced sensitivity, specificity, positive predictive, and negative predictive values of 80%, 81.25%, 57.1%, and 92.86%, respectively.
  
  
  
  The integration of MRI findings with clinical parameters can add value to a model predicting upgrading from a Gleason score of 3 + 3 = 6 in men on AS. This can potentially be used as a noninvasive approach to confirm AS patients with low-risk disease for whom biopsy may be deferred. Cancer 2017;123:1941-1948. © 2017 American Cancer Society.
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Win Shun
authors.initials: WS
authors.lastname: Lai
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.|Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Gordetsky
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: John V
authors.initials: JV
authors.lastname: Thomas
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Nix
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama.|Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D006801:Humans; D061705:Image-Guided Biopsy; D007610:Kallikreins / Q000097:blood; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D049451:Nomograms; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography; D057832:Watchful Waiting
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Gleason grade; cancer imaging; cancer progression; prostatic adenocarcinoma; upgrading