PD19-07 VARIATION IN THE POSITIVE PREDICTIVE VALUE OF PROSTATE MRI: DATA FROM THE PROSTATE BIOPSY COLLABORATIVE GROUP

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You have accessJournal of UrologyProstate Cancer: Detection & Screening II (PD19)1 May 2024PD19-07 VARIATION IN THE POSITIVE PREDICTIVE VALUE OF PROSTATE MRI: DATA FROM THE PROSTATE BIOPSY COLLABORATIVE GROUP Sunny Nalavenkata, Emily Vertosick, Alberto Briganti, Hashim Ahmed, David Eldred-Evans, Kathie Wong, Stephen Gordon, Christian Gratzke, Michael Liss, Kim Moretti, Peter Ka-Fung Chiu, Michael Müntener, John Yaxley, Cedric Poyet, Matthias Jahnen, Daniel Margolis, Manish Patel, Behfar Ehdaie, and Andrew Vickers Sunny NalavenkataSunny Nalavenkata , Emily VertosickEmily Vertosick , Alberto BrigantiAlberto Briganti , Hashim AhmedHashim Ahmed , David Eldred-EvansDavid Eldred-Evans , Kathie WongKathie Wong , Stephen GordonStephen Gordon , Christian GratzkeChristian Gratzke , Michael LissMichael Liss , Kim MorettiKim Moretti , Peter Ka-Fung ChiuPeter Ka-Fung Chiu , Michael MüntenerMichael Müntener , John YaxleyJohn Yaxley , Cedric PoyetCedric Poyet , Matthias JahnenMatthias Jahnen , Daniel MargolisDaniel Margolis , Manish PatelManish Patel , Behfar EhdaieBehfar Ehdaie , and Andrew VickersAndrew Vickers View All Author Informationhttps://doi.org/10.1097/01.JU.0001009448.41537.64.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The diagnostic test characteristics of mpMRI, such as positive predictive value (PPV), are commonly given as single estimates. However, both mpMRI quality and reporting of the resulting images are operator dependent, suggesting that estimates such as PPV might vary between sites. This has implications in patient counseling, risk modeling and use of risk calculators. We used data from the Prostate Biopsy Collaborative Group to assess variation in the probability of being assigned different PIRADS scores and the probability of high grade cancer for a given PIRADS (PPV). METHODS: Data was collected from multiple international sites (North America, Europe, and Asia-Pacific) for patients undergoing mpMRI followed by prostate biopsy. Patients were included in this analysis if they were reported to have had an MRI-targeted biopsy and had a PIRADS score 3+. Data was analyzed to compare patient demographics, clinical practice and the variation in clinical practice. Risk of being assigned PIRADS 4 or 5, and risk of high grade disease for PIRADS 4 and 5, was estimated by logistic regression with adjustment for age, race, PSA, prostate volume, DRE result, family history and prior negative biopsy. RESULTS: The cohort includes 8147 patients from 12 participating sites. After adjustment for patient risk, we found greater than 2-fold variation in the probability of being called PIRADS 4 or 5 across sites (heterogeneity p<0.001 for both). The relative risk of high-grade cancer comparing PIRADS 4 vs 3 or 5 vs 3 did not differ across institutions (meta-analytic odds ratio 3.39, 95% CI 2.84 to 4.04, heterogeneity p=0.6 and 9.78, 95% CI 7.87 to 12.1, heterogeneity p=0.7). However, there were very large differences in absolute risk of high grade disease (that is, PPV) for both PIRADS 4 and 5 (heterogeneity p<0.001 for both). The heterogeneity between both rates of PIRADS 4 and 5 and risk of high grade disease on PIRADS 4 and 5 are presented in the Figure 1. CONCLUSIONS: The probability that a given patient would be called PIRADS 4 or 5, and the resultant probability of having high-grade disease (PPV), varies enormously between different institutions. This has immediate implications for current MRI based nomograms. Better practice standardization is urgently required for mpMRI performance and subsequent radiology interpretation. Download PPT Source of Funding: NIH Grant - 5R01CA179115-05 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e442 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sunny Nalavenkata More articles by this author Emily Vertosick More articles by this author Alberto Briganti More articles by this author Hashim Ahmed More articles by this author David Eldred-Evans More articles by this author Kathie Wong More articles by this author Stephen Gordon More articles by this author Christian Gratzke More articles by this author Michael Liss More articles by this author Kim Moretti More articles by this author Peter Ka-Fung Chiu More articles by this author Michael Müntener More articles by this author John Yaxley More articles by this author Cedric Poyet More articles by this author Matthias Jahnen More articles by this author Daniel Margolis More articles by this author Manish Patel More articles by this author Behfar Ehdaie More articles by this author Andrew Vickers More articles by this author Expand All Advertisement PDF downloadLoading ...

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