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?
Bibliographic record
Abstract
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 ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".