Introduction
Multivariate risk prediction including mpMRI for indicating targeted biopsy
Study | Diagnostic work-up | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Patient recruitment | Diagnostic protocol | Outcome measurement | ||||||||||
Patient groups | Year | Number of centers | Inclusion period | Criteria | Number of men | mpMRI/bpMRI | Positive | Targeted biopsy | Systematic biopsy | All PCa | csPCa | Definition csPCa |
Biopsy-naive setting | ||||||||||||
Alberts et al. [20] | 2018 | 5 | 2012–2017 | +PSA ± DRE | 504 | mpMRI | P3-5 | Fusion | 12-cores TR | y | y | GS ≥ 3 + 4 |
Bjurlin et al. [24] (Urology) | 2018 | 1 | Jun 2012–Aug 2014 | +PSA ± DRE | 201 | mpMRI | P3-5 | Fusion | 12-cores TR | y | y | GS ≥ 7 |
1 | Jun 2012–Aug 2014 | 87 | ||||||||||
Fang et al. [23] | 2016 | 1 | Jan 2011–Nov 2013 | +PSA ± DRE ± TRUS | 894 | mpMRI | n.r. | Cognitive | 12-cores TR | y | y | GS ≥ 4 + 3 |
Mehralivand et al. [22] | 2018 | 1 | May 2015- Aug 2016 | +PSA ± DRE | 400 | mpMRI | P3-5 | Fusion | 12-cores TR | n | y | GS ≥ 3 + 4 |
2 | Apr 2013–Oct 2016 | 251 | ||||||||||
Niu et al. [25] | 2017 | 1 | Jan 2014–Sep 2015 | +PSA ± DRE ± RUS | 151 | mpMRI | n.r. | n.r. | 12-cores TR | n | y | GS ≥ 7 |
1 | Oct 2015–Oct 2016 | 74 | n | y | GS ≥ 7 | |||||||
Radtke et al. [21] | 2017 | 1 | 2012–2015 | +PSA ± DRE | 660 | mpMRI | P2-5 | fusion | 24-cores TP | n | y | GS ≥ 3 + 4 |
Prior negative biopsy setting | ||||||||||||
Alberts et al. [20] | 2018 | 5 | 2012–2015 | +PSA ± DRE, persistant suspicion | 504 | mpMRI | P3-5 | Fusion | 12-cores TR | y | y | GS ≥ 3 + 4 |
Bjurlin et al. [30] (Eur Urol Focus) | 2018 | 1 | Apr 2012–Sept 2017 | +PSA ± DRE, persistant suspicion | 104 | mpMRI | P3-5 | Fusion | 12-cores TR | y | n | |
Bjurlin et al. [24] (Urology) | 2018 | 1 | Jun 2012–Aug 2014 | +PSA ± DRE, persistant suspicion | 119 | mpMRI | P3-5 | Fusion | 12-cores TR | y | y | GS ≥ 7 |
1 | Jun 2012–Aug 2014 | 52 | ||||||||||
Huang et al. [27] | 2018 | 1 | Jan 2007–Apr 2017 | +PSA ± DRE, persistant suspicion | 231 | mpMRI | P3-5 | n.r. | 12-cores TR | y | y | GS ≥3+4 |
Radtke et al. [21] | 2017 | 1 | 2012–2017 | +PSA ± DRE, persistant suspicion | 355 | mpMRI | P2-5 | fusion | 24-cores TP | n | y | GS ≥ 3 + 4 |
Truong [26] | 2018 | 2 | Dec 2014–Dec 2016; Feb 2014–Feb 2017 | +PSA ± DRE, persistant suspicion | 285 | mpMRI | P3-5 | Fusion | 12-cores TR | y | n | n.a. |
Combined biopsy-naive and prior negative biopsy setting | ||||||||||||
Lee et al. [28] | 2017 | 1 | Jul 2012–Nov 2015 | +PSA ± DRE, persistant suspicion | 615 | bpMRI | P3-5 | Fusion | 24-40 cores TP | y | y | GS ≥ 3 + 4 /MCCL ≥ 6mm |
Van Leeuwen et al. [29] | 2018 | 1 | Apr 2012–Mar 2014 | +PSA ± DRE, persistant suspicion | 393 | mpMRI | P3-5 | Fusion/cognitive | 30-cores TP | n | y | GS ≥ 3 + 4 (> 5%)/MCCL ≥ 7 mm/ ≥ 20% core+ |
1 | Jan 2013–Dec 2014 | 198 | mpMRI | P3-5 | Cognitive | 18-cores TR/TP |
Study | Nomogram | Results | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Developing/validation cohort | Input parameters baseline model | Additional input parameters MRI-model | Prevalence | C-statistic (area under the ROC curve) | |||||||||||||
Patient groups | Year | Developing/validation cohort | Age | PSA | PSAD | Prostate volume | DRE | TRUS | Etnicity | Prior neg. bx | MRI suspicion score | Prostate volume (MRI) | Age | All PCa | csPCa | all PCa | csPCa |
Biopsy-naive setting | |||||||||||||||||
Alberts et al. [20] | 2018 | Developing | n | y | n | y | y | y | n | n | y | n | y | 58.40% | 42.30% | 0.84 | 0.84 |
Bjurlin et al. [24] | 2018 | Developing | y | n | y | n | n | n | n | n | y | n | n | 55.20% | 34.80% | 0.82 | 0.91 |
Validation | 47.10% | 31.00% | 0.78 | 0.84 | |||||||||||||
Fang et al. [23] | 2016 | Developing | y | y | n | y | y | y | n | n | y | n | n | 48.50% | 24.40% | 0.88 | 0.87 |
Mehralivand et al. [22] | 2018 | Developing | y | y | n | n | y | n | y | y | y | y | n | n.r. | 48.30% | n.a. | 0.84 |
Validation | n.r. | 38.20% | n.a. | 0.84 | |||||||||||||
Niu et al. [25] | 2017 | Developing | y | n | y (MRI) | n | n | n | n | n | y | n | n | 56% | 21% | n.a. | 0.85 |
Validation | 52% | 24% | n.a. | 0.82 | |||||||||||||
Radtke et al. [21] | 2017 | Developing and (internally) validation | y | y | n | y | y | n | n | n | y | n | n | n.r. | 45.80% | n.a. | 0.84 |
Prior negative biopsy setting | |||||||||||||||||
Alberts et al. [20] | 2018 | Developing | n | y | n | y | y | y | n | y | y | n | y | 43.10% | 28.90% | 0.79 | 0.85 |
Bjurlin et al. [30] | 2018 | Validation | y | y | n | y | n | n | n | y | y | n | n | 70.20% | 49.00% | 0.78 | .. |
Bjurlin et al. [24] | 2018 | Develop | y | n | y | n | n | n | n | y | n | n | 31.90% | 21.80% | 0.76 | 0.86 | |
Validation | 28.80% | 9.60% | 0.65 | 0.87 | |||||||||||||
Huang et al. [27] | 2018 | Developing | y | y | n | y | y | n | n | n | y | n | y | 32.50% | 25.50% | 0.88 | 0.93 |
Radtke et al. [21] | 2017 | Developing and (internally) validation | y | y | n | y | y | n | n | n | y | n | n | n.r. | 39.80% | n.a. | 0.78 |
Truong [26] | 2018 | Developing and (internally) validation | y | y | n | y | n | n | n | y | y | n | n | 53.70% | 29.00% | 0.83 | n.a. |
Combined biopsy-naive and prior negative biopsy setting | |||||||||||||||||
Lee et al. [28] | 2017 | Developing and (internally) validation | y | n | y (MRI) | n | n | n | n | y | y | n | n | 51.50% | 38.50% | 0.87 | 0.92 |
Van Leeuwen et al. [29] | 2018 | Developing | y | y | n | y | y | n | n | y | y | n | n | 57.70% | 37.90% | n.a. | 0.88 / 0.90 |
Validation | 71.10% | 44.70% | n.a. | 0.86 |
In biopsy-naïve setting
Study | Test threshold | Baseline-model | MRI-model | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Test results percentage | Test results percentage | ||||||||||||||||
Positive test | Negative test | Positive test | Negative test | ||||||||||||||
Men biopsied | csPCa detected | cisPCa detected | Men not biopsied | csPCa missed | cisPCa missed | csPCa missed | cisPCa missed | Men biopsied | csPCa detected | cisPCa detected | Men not biopsied | csPCa missed | cisPCa missed | csPCa missed | cisPCa missed | ||
(% of all men) | TP (% of A) | (% of A) | (% of all men) | FN (% of B) | (% of B) | (% of all csPCa) | (% of all cisPCa) | (% of all men) | TP (% of A) | (% of A) | (% of all men) | FN (% of B) | (% of B) | (% of all csPCa) | (% of all cisPCa) | ||
Biopsy-naive setting | |||||||||||||||||
Alberts et al. [20] | 0% | 100.0% | 42.3% | 16.1% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 42.3% | 16.1% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
5% | 99.8% | 42.4% | 16.1% | 0.2% | 0.0% | 0.0% | 0.0% | 0.0% | 98.0% | 42.9% | 16.2% | 2.0% | 15.0% | 10.0% | 0.7% | 1.2% | |
10% | 99.4% | 42.4% | 16.2% | 0.6% | 33.3% | 0.0% | 0.5% | 0.0% | 85.7% | 47.7% | 16.7% | 14.3% | 9.8% | 12.6% | 3.3% | 11.2% | |
15% | 94.6% | 43.4% | 16.2% | 5.4% | 22.2% | 14.8% | 2.8% | 5.0% | 76.2% | 52.9% | 17.7% | 23.8% | 8.4% | 10.9% | 4.7% | 16.1% | |
20% | 84.3% | 47.6% | 17.2% | 15.7% | 14.0% | 10.2% | 5.2% | 9.9% | 67.5% | 57.6% | 16.1% | 32.5% | 10.5% | 16.0% | 8.0% | 32.3% | |
Fang et al. [23] | 0% | 100.0% | 24.4% | 24.1% | 0.0% | 0.0% | 0.0% | 100.0% | 24.4% | 24.1% | 0.0% | 0.0% | 0.0% | 0.0% | |||
5% | |||||||||||||||||
10% | 90.1% | 27.0% | 9.9% | 1.0% | 0.2% | 90.2% | 27.1% | 9.8% | 0.0% | 0.0% | |||||||
15% | |||||||||||||||||
20% | 80.2% | 29.6% | 19.8% | 3.5% | 1.7% | 80.2% | 30.0% | 19.8% | 1.5% | 0.7% | |||||||
Mehralivand et al. [22] | 0% | 100.0% | 38.2% | 19.8% | 0.0% | 0.0% | 0.0% | 100.0% | 38.2% | 19.8% | 0.0% | 0.0% | 0.0% | 0.0% | |||
5% | |||||||||||||||||
10% | 100.0% | 38.2% | 0.0% | 0.0% | 0.0% | 82.8% | 44.8% | 17.2% | 6.4% | 2.9% | |||||||
15% | 98.1% | 38.9% | 1.9% | 0.0% | 0.0% | 75.0% | 48.9% | 25.0% | 6.1% | 4.0% | |||||||
20% | 94.7% | 39.9% | 5.3% | 7.5% | 1.0% | 62.4% | 54.5% | 37.6% | 11.2% | 11.0% | |||||||
Radtke et al. [21] | 0% | 100.0% | 45.8% | 0.0% | 0.0% | 0.0% | 100.0% | 45.8% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | ||||
5% | 97.5% | 46.1% | 2.5% | 36.0% | 2.0% | 98.9% | 46.3% | 1.1% | 0.0% | 0.0% | |||||||
10% | 94.7% | 47.4% | 5.3% | 17.0% | 2.0% | 89.9% | 49.9% | 10.1% | 8.9% | 2.0% | |||||||
15% | |||||||||||||||||
20% | 82.1% | 52.5% | 17.9% | 15.1% | 5.9% | 71.9% | 58.6% | 28.1% | 13.2% | 8.1% | |||||||
Prior negative biopsy setting | |||||||||||||||||
Alberts et al. [20] | 0% | 100.0% | 28.9% | 14.2% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 28.9% | 14.2% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
5% | 99.7% | 29.0% | 14.2% | 0.3% | 0.0% | 0.0% | 0.0% | 0.0% | 73.5% | 38.4% | 14.3% | 26.5% | 2.6% | 14.0% | 2.4% | 26.1% | |
10% | 90.1% | 31.1% | 13.5% | 9.9% | 9.1% | 20.2% | 3.1% | 14.1% | 63.9% | 42.9% | 13.6% | 36.1% | 4.2% | 15.2% | 5.2% | 38.7% | |
15% | 72.0% | 37.1% | 15.6% | 28.0% | 7.9% | 10.7% | 7.6% | 21.1% | 58.6% | 45.6% | 14.5% | 41.4% | 5.3% | 13.8% | 7.6% | 40.1% | |
20% | 60.2% | 39.7% | 14.0% | 39.8% | 12.6% | 14.6% | 17.3% | 40.8% | 52.5% | 48.8% | 14.5% | 47.5% | 6.9% | 13.9% | 11.4% | 46.5% | |
Radtke et al. [21] | 0% | 100.0% | 39.8% | 0.0% | 0.0% | 0.0% | 100.0% | 39.8% | 0.0% | 0.0% | 0.0% | ||||||
5% | 98.0% | 39.8% | 2.0% | 40.0% | 2.0% | 97.6% | 40.8% | 2.4% | 0.0% | 0.0% | |||||||
10% | 93.6% | 40.8% | 6.4% | 25.0% | 4.0% | 89.2% | 43.3% | 10.8% | 11.1% | 3.0% | |||||||
15% | |||||||||||||||||
20% | 80.6% | 45.4% | 19.4% | 16.5% | 8.0% | 68.7% | 50.9% | 31.3% | 15.3% | 12.1% | |||||||
Combined biopsy-naive and prior negative biopsy setting | |||||||||||||||||
Lee et al. [28] | 0% | 100.0% | 38.5% | 13.0% | 100.0% | 38.5% | 13.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | |||||
5% | 95.6% | 40.1% | 13.1% | 4.4% | 3.7% | 11.1% | 0.4% | 3.8% | |||||||||
10% | 89.4% | 42.7% | 12.9% | 10.6% | 3.1% | 13.8% | 0.8% | 11.3% | |||||||||
15% | 82.0% | 46.4% | 12.5% | 18.0% | 2.7% | 15.3% | 1.3% | 21.3% | |||||||||
20% | 74.1% | 51.0% | 12.5% | 25.9% | 2.5% | 14.5% | 1.7% | 28.8% | |||||||||
Van Leeuwen et al. [29] | 0% | 100.0% | 37.9% | 57.8% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 100.0% | 37.9% | 57.8% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
5% | 92.6% | 40.7% | 61.0% | 7.4% | 2.7% | 17.6% | 0.5% | 2.2% | 81.4% | 46.6% | 66.2% | 18.6% | 0.0% | 20.4% | 0.0% | 6.6% | |
10% | 84.5% | 44.3% | 64.5% | 15.5% | 3.2% | 21.3% | 1.3% | 5.7% | 71.8% | 51.4% | 70.2% | 28.2% | 3.5% | 26.2% | 2.6% | 12.8% | |
15% | 74.6% | 48.8% | 67.8% | 25.4% | 5.9% | 28.3% | 4.0% | 12.5% | 62.1% | 56.5% | 74.6% | 37.9% | 7.4% | 30.3% | 7.4% | 19.9% | |
20% |
In prior negative biopsy setting
In combined biopsy-naïve and prior negative biopsy setting
Performance analysis of the MRI risk prediction models
Study | Test threshold | Baseline-model | MRI-model | Comparison MRI- and baseline-model | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Performance measures related to clinical usefulness | Performance measures related to clinical usefulness | Performance measures related to clinical usefulness | ||||||||||||||
Avoided Biopsy | Avoided cisPCa | True positive rate (TPR) Sensitivity | False positive rate (FPR) 1-Specificity | Net benefit (NB) | Avoided Biopsy | Avoided cisPCa | True positive rate (TPR) Sensitivity | False positive rate (FPR) 1-Specificity | Net benefit (NB) | Avoided Biopsy | Avoided cisPCa | True positive rate (TPR) Sensitivity | False positive rate (FPR) 1-Specificity | Net benefit (NB) | ||
Biopsy-naive setting | ||||||||||||||||
Alberts et al. [20] | 0% | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
5% | 0.002 | 0.000 | 1.000 | 0.997 | 0.393 | 0.020 | 0.012 | 0.993 | 0.971 | 0.391 | 1.8% | 1.2% | − 0.7% | − 2.6% | − 0.2% | |
10% | 0.006 | 0.000 | 0.995 | 0.993 | 0.357 | 0.143 | 0.112 | 0.967 | 0.776 | 0.359 | 13.7% | 11.2% | − 2.8% | − 21.7% | 0.2% | |
15% | 0.054 | 0.050 | 0.972 | 0.927 | 0.317 | 0.238 | 0.161 | 0.953 | 0.622 | 0.340 | 18.4% | 11.2% | -1.9% | -30.5% | 2.3% | |
20% | 0.157 | 0.099 | 0.948 | 0.766 | 0.291 | 0.325 | 0.323 | 0.920 | 0.496 | 0.318 | 16.8% | 22.4% | − 2.8% | − 27.0% | 2.7% | |
Fang et al. [23] | 0% | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | |||
5% | ||||||||||||||||
10% | 0.099 | 0.995 | 0.871 | 0.170 | 0.098 | 1.000 | 0.870 | 0.171 | − 0.1% | 0.5% | − 0.1% | 0.1% | ||||
15% | ||||||||||||||||
20% | 0.198 | 0.972 | 0.747 | 0.096 | 0.198 | 0.986 | 0.743 | 0.100 | 0.0% | 1.4% | − 0.4% | 0.4% | ||||
Mehralivand et al. [22] | 0% | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | |||
5% | ||||||||||||||||
10% | 0 | 1.000 | 1.000 | 0.313 | 0.172 | 0.970 | 0.739 | 0.320 | 17.2% | − 3.0% | − 26.1% | 0.7% | ||||
15% | 0.019 | 1.000 | 0.969 | 0.276 | 0.250 | 0.960 | 0.620 | 0.299 | 23.1% | − 4.0% | − 34.9% | 2.3% | ||||
20% | 0.053 | 0.990 | 0.921 | 0.236 | 0.376 | 0.890 | 0.460 | 0.269 | 32.3% | − 10.0% | − 46.1% | 3.3% | ||||
Radtke et al. [21] | 0% | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | |||
5% | 0.025 | 0.980 | 0.970 | 0.421 | 0.011 | 1.000 | 0.980 | 0.430 | − 1.4% | 2.0% | 0.9% | 0.9% | ||||
10% | 0.053 | 0.980 | 0.919 | 0.394 | 0.101 | 0.980 | 0.830 | 0.399 | 4.8% | 0.0% | − 8.9% | 0.5% | ||||
15% | ||||||||||||||||
20% | 0.179 | 0.941 | 0.720 | 0.334 | 0.281 | 0.919 | 0.550 | 0.347 | 10.2% | − 2.2% | − 17.0% | 1.3% | ||||
Prior negative biopsy setting | ||||||||||||||||
Alberts et al. [20] | 0% | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
5% | 0.003 | 0.000 | 1.000 | 0.996 | 0.252 | 0.265 | 0.261 | 0.976 | 0.637 | 0.258 | 26.2% | 26.1% | − 2.4% | − 35.9% | 0.6% | |
10% | 0.099 | 0.141 | 0.969 | 0.873 | 0.211 | 0.361 | 0.387 | 0.948 | 0.513 | 0.233 | 26.2% | 24.6% | − 2.1% | − 36.0% | 2.2% | |
15% | 0.28 | 0.211 | 0.924 | 0.637 | 0.187 | 0.414 | 0.401 | 0.924 | 0.449 | 0.211 | 13.4% | 19.0% | 0.0% | − 18.8% | 2.4% | |
20% | 0.398 | 0.408 | 0.827 | 0.511 | 0.148 | 0.475 | 0.465 | 0.886 | 0.378 | 0.189 | 7.7% | 5.6% | 5.9% | − 13.2% | 4.1% | |
Radtke et al. [21] | 0% | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | |||
5% | 0.020 | 0.980 | 0.980 | 0.359 | 0.024 | 1.000 | 0.960 | 0.368 | 0.4% | 2.0% | − 2.0% | 0.9% | ||||
10% | 0.064 | 0.960 | 0.920 | 0.320 | 0.108 | 0.970 | 0.841 | 0.330 | 4.4% | 1.0% | − 8.0% | 0.9% | ||||
15% | ||||||||||||||||
20% | 0.194 | 0.920 | 0.731 | 0.256 | 0.313 | 0.879 | 0.560 | 0.266 | 11.9% | − 4.0% | − 17.1% | 1.0% | ||||
Combined biopsy-naive and prior negative biopsy setting | ||||||||||||||||
Lee et al. [28] | 0% | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | ||
5% | 0.044 | 0.038 | 0.996 | 0.931 | 0.353 | |||||||||||
10% | 0.106 | 0.113 | 0.992 | 0.833 | 0.325 | |||||||||||
15% | 0.180 | 0.213 | 0.987 | 0.714 | 0.303 | |||||||||||
20% | 0.259 | 0.288 | 0.983 | 0.590 | 0.288 | |||||||||||
Van Leeuwen et al. [29] | 0% | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.000 | 0.000 | 1.000 | 1.000 | 0.000 | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
5% | 0.074 | 0.022 | 0.995 | 0.884 | 0.348 | 0.186 | 0.066 | 1.000 | 0.700 | 0.356 | 11.2% | 4.3% | 0.5% | − 18.4% | 0.8% | |
10% | 0.155 | 0.057 | 0.987 | 0.758 | 0.322 | 0.282 | 0.128 | 0.974 | 0.562 | 0.330 | 12.7% | 7.1% | − 1.3% | − 19.6% | 0.9% | |
15% | 0.254 | 0.125 | 0.960 | 0.615 | 0.297 | 0.379 | 0.199 | 0.926 | 0.435 | 0.303 | 12.5% | 7.4% | − 3.4% | − 18.0% | 0.7% | |
20% |