| Title: |
What Type of Prostate Cancer Is Systematically Overlooked by Multiparametric Magnetic Resonance Imaging? An Analysis from the PROMIS Cohort |
| Authors: |
Norris, JM; Carmona Echeverria, LM; Bott, SRJ; Brown, LC; Burns-Cox, N; Dudderidge, T; El-Shater Bosaily, A; Frangou, E; Freeman, A; Ghei, M; Henderson, A; Hindley, RG; Kaplan, RS; Kirkham, A; Oldroyd, R; Parker, C; Persad, R; Punwani, S; Rosario, DJ; Shergill, IS; Stavrinides, V; Winkler, M; Whitaker, HC; Ahmed, HU; Emberton, M |
| Source: |
European Urology (2020) |
| Publisher Information: |
Elsevier BV |
| Publication Year: |
2020 |
| Collection: |
University College London: UCL Discovery |
| Subject Terms: |
False negative magnetic resonance imaging; Undetected cancer; Multiparametric magnetic resonance imaging; PROMISProstate cancer |
| Description: |
Background: All risk stratification strategies in cancer overlook a spectrum of disease. The Prostate MR Imaging Study (PROMIS) provides a unique opportunity to explore cancers that are overlooked by multiparametric magnetic resonance imaging (mpMRI). Objective: To summarise attributes of cancers that are systematically overlooked by mpMRI. Design, setting, and participants: PROMIS tested performance of mpMRI and transrectal ultrasonography (TRUS)-guided biopsy, using 5 mm template mapping (TPM) biopsy as the reference standard. Outcome measurements and statistical analysis: Outcomes were overall and maximum Gleason scores, maximum cancer core length (MCCL), and prostate-specific antigen density (PSAD). Cancer attributes were compared between cancers that were overlooked and those that were detected. Results and limitations: Of men with cancer, 7% (17/230; 95% confidence interval [CI] 4.4–12%) had significant disease overlooked by mpMRI according to definition 1 (Gleason ≥ 4 + 3 of any length or MCCL ≥ 6 mm of any grade) and 13% (44/331; 95% CI 9.8–17%) according to definition 2 (Gleason ≥ 3 + 4 of any length or MCCL ≥ 4 mm). In comparison, TRUS-guided biopsy overlooked 52% (119/230; 95% CI 45–58%) of significant disease by definition 1 and 40% (132/331; 95% CI 35–45%) by definition 2. Prostate cancers undetected by mpMRI had significantly lower overall and maximum Gleason scores (p = 0.0007; p < 0.0001) and shorter MCCL (median difference: 3 mm [5 vs 8 mm], p < 0.0001; 95% CI 1–3) than cancers that were detected. No tumours with overall Gleason score > 3 + 4 (Gleason Grade Groups 3–5; 95% CI 0–6.4%) or maximum Gleason score > 4 + 3 (Gleason Grade Groups 4–5; 95% CI 0–8.0%) on TPM biopsy were undetected by mpMRI. Application of a PSAD threshold of 0.15 reduced the proportion of men with undetected cancer to 5% (12/230; 95% CI 2.7–8.9%) for definition 1 and 9% (30/331; 95% CI 6.2–13%) for definition 2. Application of a PSAD threshold of 0.10 reduced the proportion of men with undetected disease to 3% ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| Relation: |
https://discovery.ucl.ac.uk/id/eprint/10096926/ |
| Availability: |
https://discovery.ucl.ac.uk/id/eprint/10096926/1/1-s2.0-S030228382030261X-main.pdf; https://discovery.ucl.ac.uk/id/eprint/10096926/ |
| Rights: |
open |
| Accession Number: |
edsbas.A222763E |
| Database: |
BASE |