Background:Gleason score grading is a cornerstone of risk stratification and management of patients with prostate cancer(PCa).In this work,we derive and validate a nomogram that uses prostate multiparametric magnetic ...Background:Gleason score grading is a cornerstone of risk stratification and management of patients with prostate cancer(PCa).In this work,we derive and validate a nomogram that uses prostate multiparametric magnetic resonance imaging(MP-MRI)and clinical patient characteristics to predict biopsy Gleason scores(bGS).Materials and methods:A predictive nomogram was derived from 143 men who underwent MP-MRI prior to any prostate biopsy and then validated on an independent cohort of 235 men from a different institution who underwent MP-MRI for PCa workup.Screen positive lesions were defined as lesions positive on T2W and DWI sequences on MP-MRI.Prostate specific antigen(PSA)density,number of screen positive lesions,and MRI suspicion were associated with PCa Gleason score on biopsy and were used to generate a predictive nomogram.The independent cohort was tested on the nomogram and the most likely bGS was noted.Results:The mean PSA in the validation cohort was 9.25ng/mL versus 6.8ng/mL in the original cohort(p=0.001).The distribution of Gleason scores between the 2 cohorts were not significantly different(p=0.7).In the original cohort of men,the most probable nomogram generated Gleason score agreed with actual pathologic bGS findings in 61%of the men.In the validation cohort,the most likely nomogram predicted bGS agreed with actual pathologic bGS 51%of the time.The nomogram correctly identified any PCa versus non-PCa 63%of the time and clinically significant(Gleason score≥7)PCa 69%of the time.The negative predictive value for clinically significant PCa using this prebiopsy nomogram was 74%in the validation group.Conclusions:A preintervention nomogram based on PSA and MRI findings can help narrow down the likely pathologic finding on biopsy.Validation of the nomogram demonstrated a significant ability to correctly identify the most likely bGS.This feasibility study demonstrates the potential of a prebiopsy prediction of bGS and based on the high negative predictive value,identification of men who may not need biopsies,which could impact future risk stratification for PCa.展开更多
文摘Background:Gleason score grading is a cornerstone of risk stratification and management of patients with prostate cancer(PCa).In this work,we derive and validate a nomogram that uses prostate multiparametric magnetic resonance imaging(MP-MRI)and clinical patient characteristics to predict biopsy Gleason scores(bGS).Materials and methods:A predictive nomogram was derived from 143 men who underwent MP-MRI prior to any prostate biopsy and then validated on an independent cohort of 235 men from a different institution who underwent MP-MRI for PCa workup.Screen positive lesions were defined as lesions positive on T2W and DWI sequences on MP-MRI.Prostate specific antigen(PSA)density,number of screen positive lesions,and MRI suspicion were associated with PCa Gleason score on biopsy and were used to generate a predictive nomogram.The independent cohort was tested on the nomogram and the most likely bGS was noted.Results:The mean PSA in the validation cohort was 9.25ng/mL versus 6.8ng/mL in the original cohort(p=0.001).The distribution of Gleason scores between the 2 cohorts were not significantly different(p=0.7).In the original cohort of men,the most probable nomogram generated Gleason score agreed with actual pathologic bGS findings in 61%of the men.In the validation cohort,the most likely nomogram predicted bGS agreed with actual pathologic bGS 51%of the time.The nomogram correctly identified any PCa versus non-PCa 63%of the time and clinically significant(Gleason score≥7)PCa 69%of the time.The negative predictive value for clinically significant PCa using this prebiopsy nomogram was 74%in the validation group.Conclusions:A preintervention nomogram based on PSA and MRI findings can help narrow down the likely pathologic finding on biopsy.Validation of the nomogram demonstrated a significant ability to correctly identify the most likely bGS.This feasibility study demonstrates the potential of a prebiopsy prediction of bGS and based on the high negative predictive value,identification of men who may not need biopsies,which could impact future risk stratification for PCa.
