MRI-Based Risk Calculators May Improve Patient Selection for Prostate Biopsy – Renal and Urology News

Among MRI-based risk calculators for prostate biopsy, 2 models provide more consistent predictions across different populations, a new study finds.

Investigators externally validated 4 models using several real-world populations from Europe and North America including 2181 men, including some with African ancestry. The MRI-based prostate cancer risk calculators from North America were the Prospective Loyola University Multiparametric MRI (PLUM) and UCLA (University of California, Los Angeles)-Cornell models. The calculators from Europe included the Van Leeuwen and Rotterdam Prostate Cancer Risk Calculator-MRI (RPCRC-MRI).

All models underpredicted the risk of clinically significant prostate cancer to some degree, Hiten D. Patel, MD, MPH, of Northwestern University in Chicago, Illinois, and colleagues reported in JAMA Network Open. All 4models had good discrimination in the European (AUC, 0.90) and North American (AUCs, 0.83-0.85) cohorts. The RPCRC-MRI and PLUM models offered better calibration.

The 2 models with the greatest accuracy were the RPCRC-MRI and PLUM models, the investigators reported, but prediction could be improved by incorporating advanced biomarkers beyond PSA.

Recent studies, including the STHLM3-MRI trial (NCT03377881) and GÖTEBORG-2 (ISRCTN94604465), have examined the use of PSA cutoffs and MRI for prostate cancer screening.

“The MRI-based PCa risk calculators can provide more nuanced risk estimates for PCa screening by considering continuous values for PSA levels and PI-RADS rather than strict cutoffs and incorporating other ‘free’ clinical risk factors such as age, family history, race and ethnicity, and prostate volume,” according to Dr Patel’s team.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.