Highlights
- •Patients with negative MRI can be safely followed-up without a prostate biopsy.
- •PSA Density levels should guide prostate cancer screening in the community.
- •Age, PSA Density and Likert score are associated with the risk of significant cancer.
- •The RosCaP score may support decision to biopsy in low to equivocal risk cases.
Abstract
Introduction
Clinically significant prostate cancer (csCaP) with Gleason ≥3 + 4 is found in 10%
negative prebiopsy multiparametric (mp) MRI cases and varies widely for equivocal
mpMRI cases. The objective of this study was to investigate long-term outcomes of
patients with negative and equivocal mpMRIs and to develop a predictive score for
csCaP risk stratification in this group.
Patients and Methods
Patients who underwent an upfront mpMRI between May 2015 and March 2018 with an MRI
score Likert 1 to 3 were included in the study. Patients had either a CaP diagnosis
at MRI-targeted biopsy or were not diagnosed and attended follow-up in the community.
Outcomes were analysed through the Kaplan-Meier estimator and Cox Model. Regression
coefficients of significant variables were used to develop a Risk of significant Cancer
of the Prostate score (RosCaP).
Results
At first assessment 281/469 patients had mpMRI only and 188/469 mpMRI and biopsy,
26 csCaP were found at biopsy, including 10/26 in Likert 3 patients. 12/371 patients
discharged without CaP after first assessment were diagnosed with csCaP during a median
of 34.2 months’ follow-up, 11/12 diagnosis occurred in patients omitting initial biopsy.
csCaP diagnosis-free survival was 95.7% in the MRI group and 99.1% in the biopsy group.
From these outcomes, a continuous RosCaP score was developed: RosCaP = 0.083 x Age
- 0.202 x (1/PSA Density) + 0.786 (if Likert 3), and 4 risk classes were proposed.
Limitations include retrospective design and absence of external validation.
Conclusion
Age, PSA Density and MRI Likert score were significantly associated to the risk of
csCaP and utilised to devise the novel RosCap predictive score focused to support
risk assessment in patients with negative or equivocal mpMRI results.
Keywords
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Article info
Publication history
Published online: July 28, 2022
Accepted:
July 25,
2022
Received in revised form:
July 21,
2022
Received:
June 20,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
