PD55-12 INCREMENTAL UTILITY OF MP-MRI PERFORMED BEFORE CONFIRMATORY BIOPSY IN REDUCING THE RISK OF PROGRESSION DURING ACTIVE SURVEILLANCE FOR MEN WITH LOW RISK PROSTATE CANCER: IS IMAGING ALWAYS USEFUL?
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Résumé
You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III (PD55)1 Apr 2019PD55-12 INCREMENTAL UTILITY OF MP-MRI PERFORMED BEFORE CONFIRMATORY BIOPSY IN REDUCING THE RISK OF PROGRESSION DURING ACTIVE SURVEILLANCE FOR MEN WITH LOW RISK PROSTATE CANCER: IS IMAGING ALWAYS USEFUL? Marco Bandini, Luigi Nocera*, Simone Scarcella, Nazareno Suardi, Giorgio Gandaglia, Nicola Fossati, Armando Stabile, Shahrokh Shariat, Pierre Karakiewicz, Paolo Dell'Oglio, Nicola Longo, Vincenzo Mirone, Simone Scuderi, Daniele Robesti, Aldo Rizzo, Donato Cannoletta, Francesco Barletta, Antony Pellegrino, Francesco Montorsi, and Alberto Briganti Marco BandiniMarco Bandini More articles by this author , Luigi Nocera*Luigi Nocera* More articles by this author , Simone ScarcellaSimone Scarcella More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Armando StabileArmando Stabile More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Pierre KarakiewiczPierre Karakiewicz More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Nicola LongoNicola Longo More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Aldo RizzoAldo Rizzo More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557079.17509.d9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: The strongest evidence in favor of the use of mp-MRI in active surveillance (AS) for low risk prostate cancer (PCa) is prior to confirmatory biopsy. However, whether all patients benefit from mp-MRI in this setting is currently unknown. Indeed, it is possible that in very low-risk PCa patients the risk of missing clinically significant PCa is so low that the added value of subsequent imaging is minimal. We hypothesized that the clinical utility of mp-MRI before confirmatory biopsy to predict AS progression depends significantly on PCa features METHODS: Between 2007-18, we enrolled in our AS program patients with low risk PCa (PSA<10ng/ml, cT stage ≤T2a and Gleason Score 6). Mp-MRI was suggested to patients after the enrollment of AS, before confirmatory biopsy. Multivariable Cox regression model (Age, cT stage, baseline PSA, % of positive cores and prostate volume) predicting progression (Gleason ≥3+4) was developed for patients who did not underwent MRI. C-index quantified the discrimination accuracy of our model. We then tested the interaction between the use of MRI and the probability of progression according to the newly developed model. The nonparametric curve fitting method graphically explored the relationship between the risk of progression and actual progression rate RESULTS: We enrolled 235 patients. Overall, MRI was performed in 139 (60%) patients. Within a median follow-up of 25.2 months, 92 (39%) patients had progression. The C-index of our model was 84%. The interaction between the use of MRI and the risk of progression was statistically significant (p=0.04). The nonparametric curve fitting method showed that the use of MRI was associated with reduced risk of progression only for those patients with predicted probabilities >30% (Fig) CONCLUSIONS: Our results suggest that the utility of mp-MRI before confirmatory biopsy in men on AS vary significantly according to patient profile. In patients with very low risk PCa, according to our model, the added value of mp-MRI in reducing the risk of progression or misclassification is minimal. Thus, mp-MRI can be safely spared in these men. Only patients with a baseline probability of progression >30% might benefit from mp-MRI in order to exclude clinically significant PCa Source of Funding: none Milan, Italy; Vienna, Austria; Montreal, Canada; Milan, Italy; Naples, Italy; Milan, Italy© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1016-e1017 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Bandini More articles by this author Luigi Nocera* More articles by this author Simone Scarcella More articles by this author Nazareno Suardi More articles by this author Giorgio Gandaglia More articles by this author Nicola Fossati More articles by this author Armando Stabile More articles by this author Shahrokh Shariat More articles by this author Pierre Karakiewicz More articles by this author Paolo Dell'Oglio More articles by this author Nicola Longo More articles by this author Vincenzo Mirone More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Aldo Rizzo More articles by this author Donato Cannoletta More articles by this author Francesco Barletta More articles by this author Antony Pellegrino More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».