OPTIMIZING THE UTILITY OF A PROSTATE MULTIPARAMETRIC-MRI BASED NOMOGRAM FOR PROSTATE CANCER ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Staging (I)1 Apr 2013246 OPTIMIZING THE UTILITY OF A PROSTATE MULTIPARAMETRIC-MRI BASED NOMOGRAM FOR PROSTATE CANCER ACTIVE SURVEILLANCE M. Minhaj Siddiqui, Lambros Stamatakis, Jennifer Logan, Soroush Rais-Bahrami, Jeffrey Nix, Anthony Hoang, Annerleim Walton-Diaz, Srinivas Vourganti, Hong Truong, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto M. Minhaj SiddiquiM. Minhaj Siddiqui Bethesda, MD More articles by this author , Lambros StamatakisLambros Stamatakis Bethesda, MD More articles by this author , Jennifer LoganJennifer Logan Bethesda, MD More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami Bethesda, MD More articles by this author , Jeffrey NixJeffrey Nix Bethesda, MD More articles by this author , Anthony HoangAnthony Hoang Bethesda, MD More articles by this author , Annerleim Walton-DiazAnnerleim Walton-Diaz Bethesda, MD More articles by this author , Srinivas VourgantiSrinivas Vourganti Bethesda, MD More articles by this author , Hong TruongHong Truong Bethesda, MD More articles by this author , Baris TurkbeyBaris Turkbey Bethesda, MD More articles by this author , Peter ChoykePeter Choyke Bethesda, MD More articles by this author , Bradford WoodBradford Wood Bethesda, MD More articles by this author , and Peter PintoPeter Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1626AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric-MRI (MP-MRI) of the prostate may be beneficial in the follow-up of prostate cancer (PC) patients on active surveillance (AS). We analyze the utilization of a previously generated MP-MRI based nomogram that predicts repeat biopsy outcomes to determine the utility of MP-MRI in the management of men on AS. METHODS We reviewed 86 patients who met the Johns Hopkins AS criteria at entry based on their initial biopsy and underwent 3.0T MP-MRI with subsequent MRI/US fusion guided prostate biopsy between 2007û2012. Three factors were identified on MP-MRI to correlate with confirmatory biopsy in predicting AS candidacy: number of lesions, highest lesion suspicion, and the fraction of total prostate volume occupied by lesion (lesional density). A nomogram was developed using these three factors with good predictive characteristics (c-index 0.7, Fig. 1). Accuracy of the nomogram was assessed by comparing the calculated probability to confirmatory biopsy outcomes. RESULTS Two approaches were developed to utilize the nomogram: (1) An absolute cutoff for determination of AS candidacy and (2) A three-tiered approach to identify probability ranges for which patients should be kept on AS (green), counseled on repeat biopsy (yellow), and taken off AS to pursue definitive treatment (red). To determine the optimal cutoff for approach 1, the nomogram's accuracy in predicting biopsy results was plotted for all cutoffs between the range of 0 to 1. A peak in accuracy was seen at the cutoff of 0.5 and corresponded with a 73% accuracy (Fig 2, dashed line). To allow for clinical judgment in cases of intermediate probability, an intermediate zone was defined and cutoffs for approach 2 were determined (Fig 2, solid line) These optimized regions for the green, yellow, and red zones were 0-0.25, 0.25-0.55, and 0.55-1. With this graded approach, a 53% reduction in repeat biopsies is achieved assuming all men in the yellow zone are rebiopsied. Furthermore, the accuracy of MP-MRI for AS management is optimized to 83% with this approach. CONCLUSIONS MP-MRI based nomograms may potentially decrease the number of repeat biopsies in AS candidates. A three-tiered approach significantly increases accuracy of the nomogram while integrating clinical judgment and patient preferences in the intermediate probability range. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e101 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information M. Minhaj Siddiqui Bethesda, MD More articles by this author Lambros Stamatakis Bethesda, MD More articles by this author Jennifer Logan Bethesda, MD More articles by this author Soroush Rais-Bahrami Bethesda, MD More articles by this author Jeffrey Nix Bethesda, MD More articles by this author Anthony Hoang Bethesda, MD More articles by this author Annerleim Walton-Diaz Bethesda, MD More articles by this author Srinivas Vourganti Bethesda, MD More articles by this author Hong Truong Bethesda, MD More articles by this author Baris Turkbey Bethesda, MD More articles by this author Peter Choyke Bethesda, MD More articles by this author Bradford Wood Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...