Optimizing patient’s selection for prostate biopsy: A single institution experience with multi-parametric MRI and the 4Kscore test for the detection of aggressive prostate cancer

Sanoj Punnen, Bruno Nahar, Nachiketh Soodana-Prakash, Tulay Koru-Sengul, Radka Stoyanova, Alan Pollack, Bruce Kava, Mark L. Gonzalgo, Chad R. Ritch, Dipen J. Parekh

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Objectives To evaluate the performance of mpMRI and the 4Kscore test together for the detection of significant prostate cancer. Material and methods We selected a consecutive series of men who were referred for evaluation of prostate cancer at an academic institution and underwent mpMRI and the 4Kscore test. The primary outcome was the presence of Gleason 7 or higher cancer on biopsy of the prostate. We used logistic regression and Decision Curve Analysis to report the discrimination and clinical utility of using mpMRI and the 4Kscore test for prostate cancer detection. We modeled the probability of harboring a Gleason 7 or higher prostate cancer based on the 4Kscore test and mpMRI findings. Finally, we examined various combinations and sequences of mpMRI and the 4Kscore test and assessed the impact on biopsies avoided and cancers missed. Results Among 300 men who underwent a 4Kscore test and mpMRI, 149 (49%) underwent a biopsy. Among those, 73 (49%) had cancer, and 49 (33%) had Gleason 7 cancer. The area under the curve (AUC) for using the 4Kscore test and mpMRI together 0.82 (0.75–0.89) was superior to using the 4Kscore 0.70 (0.62–0.79) or mpMRI 0.74 (0.66–0.81) individually (p = 0.001). Similarly, decision analysis revealed the highest net benefit was achieved using both tests. Conclusions The 4Kscore test and mpMRI results provide independent, but complementary, information that enhances the prediction of higher-grade prostate cancer and improves patient’s selection for a prostate biopsy. Prospective trials are required to confirm these findings.

Original languageEnglish (US)
Article numbere0201384
JournalPloS one
Volume13
Issue number8
DOIs
StatePublished - Aug 2018

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Punnen, S., Nahar, B., Soodana-Prakash, N., Koru-Sengul, T., Stoyanova, R., Pollack, A., Kava, B., Gonzalgo, M. L., Ritch, C. R., & Parekh, D. J. (2018). Optimizing patient’s selection for prostate biopsy: A single institution experience with multi-parametric MRI and the 4Kscore test for the detection of aggressive prostate cancer. PloS one, 13(8), [e0201384]. https://doi.org/10.1371/journal.pone.0201384