Establishment of an Individualized Predictive Model to Reduce the Core Number for Systematic Prostate Biopsy: A Dual Center Study Based on Stratification of the Disease Risk Score

Zeyu Chen, Min Qu, Xianqi Shen, Shaoqin Jiang, Wenhui Zhang, Jin Ji, Yan Wang, Jili Zhang, Zhenlin Chen, Lu Lin, Mengqiang Li, Cheng Wu, Xu Gao, Zeyu Chen, Min Qu, Xianqi Shen, Shaoqin Jiang, Wenhui Zhang, Jin Ji, Yan Wang, Jili Zhang, Zhenlin Chen, Lu Lin, Mengqiang Li, Cheng Wu, Xu Gao

Abstract

Purpose: To establish an individualized prostate biopsy model that reduces unnecessary biopsy cores based on multiparameter MRI (mpMRI).

Materials and methods: This retrospective, non-inferiority dual-center study retrospectively included 609 patients from the Changhai Hospital from June 2017 to November 2020 and 431 patients from the Fujian Union Hospital between 2014 and 2019. Clinical, radiological, and pathological data were analyzed. Data from the Changhai Hospital were used for modeling by calculating the patients' disease risk scores. Data from the Fujian Union Hospital were used for external verification.

Results: Based on the data of 609 patients from the Changhai Hospital, we divided the patients evenly into five layers according to the disease risk score. The area under the receiver operating characteristic (ROC) curve (AUC) with 95% confidence intervals (CI) was analyzed. Twelve-core systemic biopsy (12-SBx) was used as the reference standard. The SBx cores from each layer were reduced to 9, 6, 5, 4, and 4. The data of 279 patients with benign pathological results from the Fujian Union Hospital were incorporated into the model. No patients were in the first layer. The accuracies of the models for the other layers were 88, 96.43, 94.87, and 94.59%. The accuracy of each layer would be increased to 96, 100, 100, and 97.30% if the diagnosis of non-clinically significant prostate cancer was excluded.

Conclusions: In this study, we established an individualized biopsy model using data from a dual center. The results showed great accuracy of the model, indicating its future clinical application.

Keywords: PI-RADS; multicenter study; multiparameter MRI; predictive models; prostate biopsy.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Chen, Qu, Shen, Jiang, Zhang, Ji, Wang, Zhang, Chen, Lin, Li, Wu and Gao.

Figures

Figure 1
Figure 1
Diagram for inclusion of patients in the study.
Figure 2
Figure 2
Biopsy point distribution diagram for the two centers (A) 12-core, Changhai Hospital; (B) 13-core, Fujian Union Hospital).
Figure 3
Figure 3
(A) T2-weighted imaging (T2WI); (B) diffusion-weighted imaging (DWI).
Figure 4
Figure 4
Biopsy point distribution diagram for the 1-core to 12-core methods.
Figure 5
Figure 5
Website application display example.

References

    1. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random Systematic Versus Directed Ultrasound Guided Transrectal Core Biopsies of the Prostate. J Urol (1989) 142:71–4. doi: 10.1016/S0022-5347(17)38664-0
    1. Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R, et al. . A Comparative Analysis of Sextant and an Extended 11-Core Multisite Directed Biopsy Strategy. J Urol (2000) 163:152–7. doi: 10.1016/S0022-5347(05)67993-1
    1. Seles M, Gutschi T, Mayrhofer K, Fischereder K, Ehrlich G, Galle G, et al. . Sampling of the Anterior Apical Region Results in Increased Cancer Detection and Upgrading in Transrectal Repeat Saturation Biopsy of the Prostate. BJU Int (2016) 117:592–7. doi: 10.1111/bju.13108
    1. Smeenge M, de la Rosette J, Wijkstra H. Current Status of Transrectal Ultrasound Techniques in Prostate Cancer. Curr Opin Urol (2012) 22:297–302. doi: 10.1097/MOU.0b013e3283548154
    1. D’Amico A, Tempany C, Cormack R, Hata N, Jinzaki M, Tuncali K, et al. . Transperineal Magnetic Resonance Image Guided Prostate Biopsy. AUA J (2000) 164:385–7. doi: 10.1016/S0022-5347(05)67366-1
    1. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. . MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med (2018) 378:1767–77. doi: 10.1056/NEJMoa1801993
    1. Baco E, Rud E, Eri LM, Moen G, Vlatkovic L, Svindland A, et al. . A Randomized Controlled Trial To Assess and Compare the Outcomes of Two-Core Prostate Biopsy Guided by Fused Magnetic Resonance and Transrectal Ultrasound Images and Traditional 12-Core Systematic Biopsy. Eur Urol (2016) 69:149–56. doi: 10.1016/j.eururo.2015.03.041
    1. Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. . Comparison of MR/ultrasound Fusion-Guided Biopsy With Ultrasound-Guided Biopsy for the Diagnosis of Prostate Cancer. JAMA (2015) 313:390–7. doi: 10.1001/jama.2014.17942
    1. Richenberg J, Logager V, Panebianco V, Rouviere O, Villeirs G, Schoots IG. The Primacy of Multiparametric MRI in Men With Suspected Prostate Cancer. Eur Radiol (2019) 29:6940–52. doi: 10.1007/s00330-019-06166-z
    1. Sonn GA, Fan RE, Ghanouni P, Wang NN, Brooks JD, Loening AM, et al. . Prostate Magnetic Resonance Imaging Interpretation Varies Substantially Across Radiologists. Eur Urol Focus (2019) 5:592–9. doi: 10.1016/j.euf.2017.11.010
    1. Lu AJ, Syed JS, Ghabili K, Hsiang WR, Nguyen KA, Leapman MS, et al. . Role of Core Number and Location in Targeted Magnetic Resonance Imaging-Ultrasound Fusion Prostate Biopsy. Eur Urol (2019) 76:14–7. doi: 10.1016/j.eururo.2019.04.008
    1. Tu X, Lin T, Cai D, Liu Z, Yang L, Wei Q. The Optimal Core Number and Site for MRI-Targeted Biopsy of Prostate? A Systematic Review and Pooled Analysis. Minerva Urol e Nefrologica = Ital J Urol Nephrol (2020) 72:144–51. doi: 10.23736/S0393-2249.20.03639-5
    1. Sathianathen N, Omer A, Harriss E, Davies L, Kasivisvanathan V, Punwani S, et al. . Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-Analysis. Europ Urol (2020) 78:402–14. doi: 10.1016/j.eururo.2020.03.048
    1. Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. . EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer. Part II—2020 Update: Treatment of Relapsing and Metastatic Prostate Cancer. Eur Urol (2021) 79:263–82. doi: 10.1016/j.eururo.2020.09.046
    1. Merriel SWD, Funston G, Hamilton W. Prostate Cancer in Primary Care. Adv Ther (2018) 35:1285–94. doi: 10.1007/s12325-018-0766-1
    1. Hu Z, Wang J, Sun D, Cui L, Ran W. How Many Cores Does Systematic Prostate Biopsy Need?: A Large-Sample Retrospective Analysis. J Ultrasound Med (2019) 38:1491–9. doi: 10.1002/jum.14834
    1. Shen WW, Cui LG, Ran WQ, Sun Y, Jiang J, Pei XL, et al. . Targeted Biopsy With Reduced Number of Cores: Optimal Sampling Scheme in Patients Undergoing Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Prostate Biopsy. Ultrasound Med Biol (2020) 46:1197–207. doi: 10.1016/j.ultrasmedbio.2020.01.017
    1. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. . PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol (2016) 69:16–40. doi: 10.1016/j.eururo.2015.08.052
    1. Wang H, Lin H, He B, Guo X, Zhou Y, Xi P, et al. . A Novel Perineal Nerve Block Approach for Transperineal Prostate Biopsy: An Anatomical Analysis-Based Randomized Single-Blind Controlled Trial. Urology (2020) 146:25–31. doi: 10.1016/j.urology.2020.01.058
    1. Rouvière O, Puech P, Renard-Penna R, Claudon M, Roy C, Mège-Lechevallier F, et al. . Use of Prostate Systematic and Targeted Biopsy on the Basis of Multiparametric MRI in Biopsy-Naive Patients (MRI-FIRST): A Prospective, Multicentre, Paired Diagnostic Study. Lancet Oncol (2019) 20:100–9. doi: 10.1016/s1470-2045(18)30569-2
    1. van der Leest M, Cornel E, Israël B, Hendriks R, Padhani A, Hoogenboom M, et al. . Head-To-Head Comparison of Transrectal Ultrasound-Guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging With Subsequent Magnetic Resonance-Guided Biopsy in Biopsy-Naïve Men With Elevated Prostate-Specific Antigen: A Large Prospective Multicenter Clinical Study. European Urology (2019) 75:570–8. doi: 10.1016/j.eururo.2018.11.023
    1. Checcucci E, Amparore D, De Luca S, Autorino R, Fiori C, Porpiglia F. Precision Prostate Cancer Surgery: An Overview of New Technologies and Techniques. Minerva Urol e Nefrologica = Ital J Urol Nephrol (2019) 71:487–501. doi: 10.23736/S0393-2249.19.03365-4
    1. Drost FH, Osses DF, Nieboer D, Steyerberg EW, Bangma CH, Roobol MJ, et al. . Prostate MRI, With or Without MRI-Targeted Biopsy, and Systematic Biopsy for Detecting Prostate Cancer. Cochrane Database Syst Rev (2019) 4:CD012663. doi: 10.1002/14651858.CD012663.pub2
    1. Distler FA, Radtke JP, Bonekamp D, Kesch C, Schlemmer HP, Wieczorek K, et al. . The Value of PSA Density in Combination With PI-RADS™ for the Accuracy of Prostate Cancer Prediction. J Urol (2017) 198:575–82. doi: 10.1016/j.juro.2017.03.130
    1. Washino S, Okochi T, Saito K, Konishi T, Hirai M, Kobayashi Y, et al. . Combination of Prostate Imaging Reporting and Data System (PI-RADS) Score and Prostate-Specific Antigen (PSA) Density Predicts Biopsy Outcome in Prostate Biopsy Naïve Patients. BJU Int (2017) 119:225–33. doi: 10.1111/bju.13465
    1. Vinjamoori AH, Jagannathan JP, Shinagare AB, Taplin ME, Oh WK, Van den Abbeele AD, et al. . Atypical Metastases From Prostate Cancer: 10-Year Experience at a Single Institution. AJR. Am J Roentgenol (2012) 199:367–72. doi: 10.2214/AJR.11.7533
    1. He B, Chen R, Gao X, Ren S, Yang B, Hou J, et al. . Nomograms for Predicting Gleason Upgrading in a Contemporary Chinese Cohort Receiving Radical Prostatectomy After Extended Prostate Biopsy: Development and Internal Validation. Oncotarget (2016) 7:17275–85. doi: 10.18632/oncotarget.7787
    1. Welch H, Albertsen P. Reconsidering Prostate Cancer Mortality - The Future of PSA Screening. N Engl J Med (2020) 382:1557–63. doi: 10.1056/NEJMms1914228
    1. Fu Z, Guo X, Zhang S, Zheng R, Zeng H, Chen R, et al. . Statistical Analysis of Incidence and Mortality of Prostate Cancer in China, 2015. Chinese J Onco (2020) 42:718–22. doi: 10.3760/cma.j.cn112152-20200313-00200

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa