Inter-center variability in positive predictive values of PIRADS score in patients undergoing prostate biopsy: Results from the PROMOD study group

You have accessJournal of UrologyCME1 Apr 2023PD39-08 INTER-CENTER VARIABILITY IN POSITIVE PREDICTIVE VALUES OF PIRADS SCORE IN PATIENTS UNDERGOING PROSTATE BIOPSY: RESULTS FROM THE PROMOD STUDY GROUP Ugo Falagario, Marco Finati, Anna Lantz, Ivan Jambor, Luca Carmignani, Emanuele Montanari, Pierluigi Bove, Paolo Gontero, Alessandro Sciarra, Pasquale Di Tonno, Carlo Trombetta, Pierfrancesco Bassi, Giuseppe Simone, Vincenzo Mirone, Alessandro Antonelli, Luigi Schips, Gian Maria Busetto, Carlo Bettocchi, Matteo Ferro, Peter Bostrom, Tobias Nordstrom, Ottavio De Cobelli, Luigi Cormio, and Giuseppe Carrieri Ugo FalagarioUgo Falagario More articles by this author , Marco FinatiMarco Finati More articles by this author , Anna LantzAnna Lantz More articles by this author , Ivan JamborIvan Jambor More articles by this author , Luca CarmignaniLuca Carmignani More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Pierluigi BovePierluigi Bove More articles by this author , Paolo GonteroPaolo Gontero More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Pasquale Di TonnoPasquale Di Tonno More articles by this author , Carlo TrombettaCarlo Trombetta More articles by this author , Pierfrancesco BassiPierfrancesco Bassi More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Luigi SchipsLuigi Schips More articles by this author , Gian Maria BusettoGian Maria Busetto More articles by this author , Carlo BettocchiCarlo Bettocchi More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Peter BostromPeter Bostrom More articles by this author , Tobias NordstromTobias Nordstrom More articles by this author , Ottavio De CobelliOttavio De Cobelli More articles by this author , Luigi CormioLuigi Cormio More articles by this author , and Giuseppe CarrieriGiuseppe Carrieri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003342.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (mp-MRI) of the prostate has a low specificity with up to 44% of PIRADS 4-5 lesions being falsely positive. Despite the effort of the PIRADS System Steering Committee to standardize parameters for image acquisition and radiology reports, mpMRI’s inter-reader and inter-center reproducibility remains moderate at best. The present study aims to evaluate inter-center variability of the positive predictive value (PPV) of MRI for the diagnosis of Prostate cancer (PCa). METHODS: We retrospectively reviewed the PRostate Mri Outcome Database (PROMOD) including all man with clinical suspicion of PCa undergoing prostate biopsy with a positive MRI (PIRADS≥3) in 24 European Institutions. The primary outcome of the study was csPCa defined as Biopsy ISUP Gleason Group (ISUP GG) ≥2. Overall and per institution PPVs were computed. Additionally, linear regression analysis was used to evaluate the association between PPV of PI-RADS scores with the csPCa prevalence as well as with proxy of csPCa prevalence such as median PSA density value and median ERSPC-Risk calculator predicted probability. RESULTS: A total of 10185 patients from 24 institutions were identified from the PROMOD dataset. 8559 had a PI-RADS≥3. Out of these, 5162 (60.3%) patients were diagnosed with PCa while 3585 (41.9%) were diagnosed with csPCa. PIRADS 3 median PPV was 18.1 (IQR: 13.6, 21.7), PIRADS 4 median PPV was 42.1 (IQR: 35.2, 49.8), PIRADS 5 median PPV was 73.6 (IQR: 63.7, 80.4). PPVs were significantly associated with center prevalence, median PSA density and median ERSPC-RC of each institution. Regression findings between PPV of each PIRADS score and characteristics of each cohort are graphically presented in Figure 1. CONCLUSIONS: Positive predictive value of MRI varies across institution. The variability is mainly due to differences in disease prevalence. Since disease prevalence is not available at the time of clinical decision, physician may use PSA density or Risk calculator to interpret mp-MRI results. The addition of these parameters to the PIRADS scoring system may help to define optimal strategies for selection of men who might benefit from prostate biopsy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1048 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ugo Falagario More articles by this author Marco Finati More articles by this author Anna Lantz More articles by this author Ivan Jambor More articles by this author Luca Carmignani More articles by this author Emanuele Montanari More articles by this author Pierluigi Bove More articles by this author Paolo Gontero More articles by this author Alessandro Sciarra More articles by this author Pasquale Di Tonno More articles by this author Carlo Trombetta More articles by this author Pierfrancesco Bassi More articles by this author Giuseppe Simone More articles by this author Vincenzo Mirone More articles by this author Alessandro Antonelli More articles by this author Luigi Schips More articles by this author Gian Maria Busetto More articles by this author Carlo Bettocchi More articles by this author Matteo Ferro More articles by this author Peter Bostrom More articles by this author Tobias Nordstrom More articles by this author Ottavio De Cobelli More articles by this author Luigi Cormio More articles by this author Giuseppe Carrieri More articles by this author Expand All Advertisement PDF downloadLoading ...