Urinary MyProstateScore (MPS) to Rule out Clinically-Significant Cancer in Men with Equivocal (PI-RADS 3) Multiparametric MRI: Addressing an Unmet Clinical Need - 13/06/22
, Udit Singhal c, d, f, #, Matthew S. Davenport c, g, John T. Wei c, Jeffrey S. Montgomery c, d, Arvin K. George c, d, Simpa S. Salami c, d, Stanley G. Mukundi c, Javed Siddiqui e, Lakshmi P. Kunju h, Benjamin P. Tooke i, C. Yoonhee Ryder i, Sarah P. Dugan i, Zoey Chopra i, Rachel Botbyl e, Yilin Feng i, Michael S. Sessine j, Nicholas W. Eyrich k, Ashley E. Ross l, Bruce J. Trock m, Scott A. Tomlins e, h, Ganesh S. Palapattu c, d, n, Arul M. Chinnaiyan c, d, e, h, o, Yashar S. Niknafs e, Todd M. Morgan c, dAbstract |
Objective |
To evaluate the complementary value of urinary MyProstateScore (MPS) testing and multiparametric MRI (mpMRI) and assess outcomes in patients with equivocal mpMRI.
Materials and Methods |
Included patients underwent mpMRI followed by urine collection and prostate biopsy at the University of Michigan between 2015 –2019. MPS values were calculated from urine specimens using the validated model based on serum PSA, urinary PCA3, and urinary TMPRSS2:ERG. In the PI-RADS 3 population, the discriminative accuracy of PSA, PSAD, and MPS for GG≥2 cancer was quantified by the AUC curve. Decision curve analysis was used to assess net benefit of MPS relative to PSAD.
Results |
There were 540 patients that underwent mpMRI and biopsy with MPS available. The prevalence of GG≥2 cancer was 13% for PI-RADS 3, 56% for PI-RADS 4, and 87% for PI-RADS 5. MPS was significantly higher in men with GG≥2 cancer [median 44.9, IQR (29.4 –57.5)] than those with negative or GG1 biopsy [median 29.2, IQR (14.8 –44.2); P <.001] in the overall population and when stratified by PI-RADS score. In the PI-RADS 3 population (n = 121), the AUC for predicting GG≥2 cancer was 0.55 for PSA, 0.62 for PSAD, and 0.73 for MPS. MPS provided the highest net clinical benefit across all pertinent threshold probabilities.
Conclusion |
In patients that underwent mpMRI and biopsy, MPS was significantly associated with GG≥2 cancer across all PI-RADS scores. In the PI-RADS 3 population, MPS significantly outperformed PSAD in ruling out GG≥2 cancer. These findings suggest a complementary role of MPS testing in patients that have undergone mpMRI.
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| Financial Disclosure: The authors declare that they have no relevant financial interests. |
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| Funding Support: JJT was supported by the National Institutes of Health/National Cancer Institute Advanced Training in Urologic Oncology Grant (T32/CA180984). His research has been funded in part by a University of Michigan Precision Health Research Scholar Award, the SPORE Career Enhancement Program (CA186786), and the Prostate Cancer Foundation Young Investigator Award. US is supported by the Urology Care Foundation – American Urological Association Research Scholar Award sponsored by the Society of Urologic Oncology and SPORE, and a National Institutes of Health Loan Repayment Program award (L30 CA264387). JTW is supported by the Early Detection Research Network and National Cancer Institute. TMM is supported by the A. Alfred Taubman Medical Research Institute. AMC is a Howard Hughes Medical Institute Investigator and an American Cancer Society Research Professor. This work was supported by the Prostate Cancer Foundation, NCI Prostate SPORE (P50 CA186786), an NCI Outstanding Investigator Award (R35CA231996), and an NCI Early Detection Research Network U01 (5U01CA214170-04). |
Vol 164
P. 184-190 - juin 2022 Retour au numéro
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