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Original Study| Volume 21, ISSUE 1, P162-170, February 2023

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Natural History of Patients with Prostate MRI Likert 1-3 and Development of RosCaP: a Multivariate Risk Score for Clinically Significant Cancer

  • Luca Orecchia
    Correspondence
    Address for correspondence: Luca Orecchia, Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK.
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

    Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
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  • Alessandra Nardi
    Affiliations
    Department of Mathematics, University of Rome Tor Vergata, Italy
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  • Peter Fletcher
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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  • Simona Ippoliti
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

    International Medical School, University of Rome Tor Vergata, Italy
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  • Jonathan Grounds
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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  • Ibifuro Dokubo
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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  • Claudia Fede Spicchiale
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

    Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
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  • Saiful Miah
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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  • Roberto Miano
    Affiliations
    Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy

    Department of Surgical Sciences, University of Rome Tor Vergata, Italy
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  • Author Footnotes
    ⁎ These authors contributed equally to this work
    Tristan Barrett
    Footnotes
    ⁎ These authors contributed equally to this work
    Affiliations
    Radiology Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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  • Author Footnotes
    ⁎ These authors contributed equally to this work
    Christof Kastner
    Footnotes
    ⁎ These authors contributed equally to this work
    Affiliations
    Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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  • Author Footnotes
    ⁎ These authors contributed equally to this work

      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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