title: A multiparametric magnetic resonance imaging-based risk model to determine the risk of significant prostate cancer prior to biopsy.
abstract: To develop and externally validate a predictive model for detection of significant prostate cancer.
  
  
  
  Development of the model was based on a prospective cohort including 393 men who underwent multiparametric magnetic resonance imaging (mpMRI) before biopsy. External validity of the model was then examined retrospectively in 198 men from a separate institution whom underwent mpMRI followed by biopsy for abnormal prostate-specific antigen (PSA) level or digital rectal examination (DRE). A model was developed with age, PSA level, DRE, prostate volume, previous biopsy, and Prostate Imaging Reporting and Data System (PIRADS) score, as predictors for significant prostate cancer (Gleason 7 with >5% grade 4, ≥20% cores positive or ≥7 mm of cancer in any core). Probability was studied via logistic regression. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling.
  
  
  
  In all, 393 men had complete data and 149 (37.9%) had significant prostate cancer. While the variable model had good accuracy in predicting significant prostate cancer, area under the curve (AUC) of 0.80, the advanced model (incorporating mpMRI) had a significantly higher AUC of 0.88 (P < 0.001). The model was well calibrated in internal and external validation. Decision analysis showed that use of the advanced model in practice would improve biopsy outcome predictions. Clinical application of the model would reduce 28% of biopsies, whilst missing 2.6% significant prostate cancer.
  
  
  
  Individualised risk assessment of significant prostate cancer using a predictive model that incorporates mpMRI PIRADS score and clinical data allows a considerable reduction in unnecessary biopsies and reduction of the risk of over-detection of insignificant prostate cancer at the cost of a very small increase in the number of significant cancers missed.
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
authors.forename: Pim J
authors.identifier: 0000-0002-5531-6104
authors.initials: PJ
authors.lastname: van Leeuwen
authors.affiliation: School of Public Health and Community Medicine, Kensington, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayen
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.|School of Public Health and Community Medicine, Kensington, New South Wales, Australia.
authors.forename: James E
authors.initials: JE
authors.lastname: Thompson
authors.affiliation: School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Moses
authors.affiliation: School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Ron
authors.initials: R
authors.lastname: Shnier
authors.affiliation: Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
authors.forename: Maret
authors.initials: M
authors.lastname: Böhm
authors.affiliation: Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
authors.forename: Magdaline
authors.initials: M
authors.lastname: Abuodha
authors.affiliation: Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Haynes
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.|School of Public Health and Community Medicine, Kensington, New South Wales, Australia.
authors.forename: Francis
authors.identifier: 0000-0002-5805-9860
authors.initials: F
authors.lastname: Ting
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Barentsz
authors.affiliation: Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Roobol
authors.affiliation: Department of Urology, Royal North Shore Private Hospital, St Leonards, New South Wales, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Vass
authors.affiliation: Department of Urology, Royal North Shore Private Hospital, St Leonards, New South Wales, Australia.
authors.forename: Krishan
authors.initials: K
authors.lastname: Rasiah
authors.affiliation: Douglass Hanly Moir Pathology and University of Notre Dame, Darlinghurst, New South Wales, Australia.
authors.forename: Warick
authors.initials: W
authors.lastname: Delprado
authors.affiliation: St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.|School of Public Health and Community Medicine, Kensington, New South Wales, Australia.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Stricker
mesh_terms: D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D018570:Risk Assessment
keywords: #PCSM; #ProstateCancer; biopsy; early detection; mpMRI; nomogram; screening