Beyond PI-RADS: Combining MRI PI-RADS and PSMA-PET/CT PRIMARY Score in a Composite (P) Score for More Accurate Diagnosis of Clinically Significant Prostate Cancer

No AccessJournal of UrologyOriginal Clinical Article17 May 2024Beyond PI-RADS: Combining MRI PI-RADS and PSMA-PET/CT PRIMARY Score in a Composite (P) Score for More Accurate Diagnosis of Clinically Significant Prostate CancerThis article is commented on by the following:Editorial Comment Louise Emmett, Nathan Papa, Thomas A. Hope, Wolfgang Fendler, Jeremie Calais, Irene Burger, Matthias Eiber, Francesco Barbato, Daniel Moon, William Counter, Nikeith John, Alan Xue, Anthony Franklin, James Thompson, Kris Rasiah, Mark Frydenberg, John Yaxley, James Buteau, Shikha Agrawal, Bao Ho, Andrew Nguyen, Victor Liu, Jonathan Lee, Henry Woo, Edward Hsiao, Thomas Sutherland, Elyse Perry, Phillip Stricker, Michael S. Hofman, Veeru Kasivisvanathan, Matthew Roberts, and Declan Murphy Louise EmmettLouise Emmett Corresponding Author: Louise Emmett, Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney ( ([email protected]) ) , Nathan PapaNathan Papa , Thomas A. HopeThomas A. Hope , Wolfgang FendlerWolfgang Fendler , Jeremie CalaisJeremie Calais , Irene BurgerIrene Burger , Matthias EiberMatthias Eiber , Francesco BarbatoFrancesco Barbato , Daniel MoonDaniel Moon , William CounterWilliam Counter , Nikeith JohnNikeith John , Alan XueAlan Xue , Anthony FranklinAnthony Franklin , James ThompsonJames Thompson , Kris RasiahKris Rasiah , Mark FrydenbergMark Frydenberg , John YaxleyJohn Yaxley , James ButeauJames Buteau , Shikha AgrawalShikha Agrawal , Bao HoBao Ho Corresponding Author: Louise Emmett, Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney ( ([email protected]) ) , Andrew NguyenAndrew Nguyen , Victor LiuVictor Liu , Jonathan LeeJonathan Lee , Henry WooHenry Woo , Edward HsiaoEdward Hsiao , Thomas SutherlandThomas Sutherland , Elyse PerryElyse Perry , Phillip StrickerPhillip Stricker , Michael S. HofmanMichael S. Hofman , Veeru KasivisvanathanVeeru Kasivisvanathan , Matthew RobertsMatthew Roberts , and Declan MurphyDeclan Murphy View All Author Informationhttps://doi.org/10.1097/JU.0000000000004010AboutPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Background: The PI-RADS score is standard of care for clinically significant prostate cancer (csPCa) diagnosis. The PRIMARY-score (PSMA-PET/CT) also has high diagnostic accuracy for csPCa. This study aimed to develop an easily calculated combined (P) score for csPCa detection (ISUP ≥ 2) incorporating separately read PI-RADS and PRIMARY scores, with external validation. Materials and Methods: Two datasets of men with suspected PCa, no prior biopsy, recent MRI and 68Ga-PSMA-11-PET/CT, and subsequent trans-perineal biopsy were evaluated. The development sample (n = 291, 56% csPCa) a prospective trial and the validation sample (n = 227, 67% csPCa) a multi-centre retrospective database. Primary outcome was detection of csPCa (ISUP ≥ 2), with ISUP ≥ 3 cancer detection a secondary outcome. Score performance was evaluated by AUC, sensitivity, specificity, and decision curve analysis. Results: The 5-point combined (P) score was developed in a prospective dataset. In the validation dataset, csPCa was identified in 0%, 20%, 52%, 96% and 100% for P score 1 to 5. The AUC was 0.93 (95%CI: 0.90-0.96), higher than PI-RADS 0.89 (95%CI: 0.85-0.93, P = .039) and PRIMARY score alone 0.84 (95%CI: 0.79-0.89, P < .001). Splitting scores at 1/2 (negative) vs 3/4/5 (positive), P score sensitivity was 94% (95%CI: 89-97) compared to PI-RADS 89% (95%CI: 83-93) and PRIMARY score 86% (95%CI: 79-91). For ISUP ≥ 3, P score sensitivity was 99% (95%CI: 95-100) vs 94% (95%CI: 88-98) and 92% (95%CI: 85-97) for PI-RADS and PRIMARY scores respectively. An SUVmax > 12 (P score 5) was ISUP ≥ 2 in all cases with 93% ISUP ≥ 3. Conclusions: The P-score is easily calculated and improves accuracy for csPCa over both PI-RADS and PRIMARY scores. It should be considered when PSMA-PET is undertaken for diagnosis. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGalgano S and Rais-Bahrami S Editorial CommentJournal of Urology, Related articlesJournal of Urology17 May 2024Editorial Comment Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsmulti-parametric MRIPSMAprostate specific membrane antigenPETprostate cancerdiagnosisMetrics Author Information Louise Emmett Corresponding Author: Louise Emmett, Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney ( ([email protected]) ) More articles by this author Nathan Papa More articles by this author Thomas A. Hope More articles by this author Wolfgang Fendler More articles by this author Jeremie Calais More articles by this author Irene Burger More articles by this author Matthias Eiber More articles by this author Francesco Barbato More articles by this author Daniel Moon More articles by this author William Counter More articles by this author Nikeith John More articles by this author Alan Xue More articles by this author Anthony Franklin More articles by this author James Thompson More articles by this author Kris Rasiah More articles by this author Mark Frydenberg More articles by this author John Yaxley More articles by this author James Buteau More articles by this author Shikha Agrawal More articles by this author Bao Ho Corresponding Author: Louise Emmett, Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney ( ([email protected]) ) More articles by this author Andrew Nguyen More articles by this author Victor Liu More articles by this author Jonathan Lee More articles by this author Henry Woo More articles by this author Edward Hsiao More articles by this author Thomas Sutherland More articles by this author Elyse Perry More articles by this author Phillip Stricker More articles by this author Michael S. Hofman More articles by this author Veeru Kasivisvanathan More articles by this author Matthew Roberts More articles by this author Declan Murphy More articles by this author Expand All Advertisement PDF downloadLoading ...