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01-12-2024 | Prostate Cancer | Original Article

The impact of prostate volume estimation on the risk‐adapted biopsy decision based on prostate-specific antigen density and magnetic resonance imaging score

Authors: Arthur Baudewyns, Karsten Guenzel, Adam Halinski, Charles Dariane, Gina Delavar, Julien Anract, Nicolas Barry Delongchamps, Teddy Jabbour, Henri-Alexandre Bourgeno, Yolène Lefebvre, Mariaconsiglia Ferriero, Giuseppe Simone, Alexandre Fourcade, Georges Fournier, Marco Oderda, Paolo Gontero, Adrian Bernal-Gomez, Alessandro Mastrorosa, Jean-Baptiste Roche, Rawad Abou Zahr, Guillaume Ploussard, Gaelle Fiard, Katerina Rysankova, Alexandre Patrick Bui, Fayek Taha, Olivier Windisch, Daniel Benamran, Léonidas Vlahopoulos, Gregoire Assenmacher, Thierry Roumeguère, Alexandre Peltier, Romain Diamand

Published in: World Journal of Urology | Issue 1/2024

Abstract

Purpose

Utility of prostate-specific antigen density (PSAd) for risk-stratification to avoid unnecessary biopsy remains unclear due to the lack of standardization of prostate volume estimation. We evaluated the impact of ellipsoidal formula using multiparametric magnetic resonance (MRI) and semi-automated segmentation using tridimensional ultrasound (3D-US) on prostate volume and PSAd estimations as well as the distribution of patients in a risk-adapted table of clinically significant prostate cancer (csPCa).

Methods

In a prospectively maintained database of 4841 patients who underwent MRI-targeted and systematic biopsies, 971 met inclusions criteria. Correlation of volume estimation was assessed by Kendall’s correlation coefficient and graphically represented by scatter and Bland–Altman plots. Distribution of csPCa was presented using the Schoots risk-adapted table based on PSAd and PI-RADS score. The model was evaluated using discrimination, calibration plots and decision curve analysis (DCA).

Results

Median prostate volume estimation using 3D-US was higher compared to MRI (49cc[IQR 37–68] vs 47cc[IQR 35–66], p < 0.001). Significant correlation between imaging modalities was observed (τ = 0.73[CI 0.7–0.75], p < 0.001). Bland–Altman plot emphasizes the differences in prostate volume estimation. Using the Schoots risk-adapted table, a high risk of csPCa was observed in PI-RADS 2 combined with high PSAd, and in all PI-RADS 4–5. The risk of csPCa was proportional to the PSAd for PI-RADS 3 patients. Good accuracy (AUC of 0.69 and 0.68 using 3D-US and MRI, respectively), adequate calibration and a higher net benefit when using 3D-US for probability thresholds above 25% on DCA.

Conclusions

Prostate volume estimation with semi-automated segmentation using 3D-US should be preferred to the ellipsoidal formula (MRI) when evaluating PSAd and the risk of csPCa.

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Title: The impact of prostate volume estimation on the risk‐adapted biopsy decision based on prostate-specific antigen density and magnetic resonance imaging score
Authors: Arthur Baudewyns
Karsten Guenzel
Adam Halinski
Charles Dariane
Gina Delavar
Julien Anract
Nicolas Barry Delongchamps
Teddy Jabbour
Henri-Alexandre Bourgeno
Yolène Lefebvre
Mariaconsiglia Ferriero
Giuseppe Simone
Alexandre Fourcade
Georges Fournier
Marco Oderda
Paolo Gontero
Adrian Bernal-Gomez
Alessandro Mastrorosa
Jean-Baptiste Roche
Rawad Abou Zahr
Guillaume Ploussard
Gaelle Fiard
Katerina Rysankova
Alexandre Patrick Bui
Fayek Taha
Olivier Windisch
Daniel Benamran
Léonidas Vlahopoulos
Gregoire Assenmacher
Thierry Roumeguère
Alexandre Peltier
Romain Diamand
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Published in: World Journal of Urology / Issue 1/2024
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-024-04962-x

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Springer Medicine

The impact of prostate volume estimation on the risk‐adapted biopsy decision based on prostate-specific antigen density and magnetic resonance imaging score

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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