Development and validation of nomogram to improve the specificity of multiparametric MRI for clinically significant prostate cancer

Abstract

ObjectiveTo develop and validate a nomogram to improve the specificity of prostate imaging reporting and data system (PI‐RADS) on multiparametric magnetic resonance imaging (MRI) for clinically significant prostate cancer on targeted fusion biopsy.MethodsA retrospective review of patients who underwent fusion biopsy for PI‐RADS 3–5 lesions using UroNav and Artemis systems between 2016 and 2022 was performed. Patients were divided into those with CS disease on fusion biopsy (Gleason grade group ≥2) versus those without. Multivariable analysis was used to identify variables associated with CS disease. A 100‐point nomogram was constructed, and ROC curve was generated.Results1485 lesions (1032 patients) were identified, 510 (34%) were PI‐RADS 3, 586 (40%) were PI‐RADS 4, and 389 (26%) were PI‐RADS 5. Of these, 11% of PI‐RADS 3, 39% of PI‐RADS 4, and 61% of PI‐RADS 5 showed CS disease. CS disease was associated with older age (OR 1.04, 95% CI 1.02–1.06, p < 0.01), previous negative biopsy (OR 0.52, 95% CI 0.36–0.74, p < 0.01), presence of multiple PI‐RADS 3–5 lesions (OR 0.61, 95% CI 0.45–0.83, p < 0.01), peripheral zone location (OR 1.88, 95% CI 1.30–2.70, p < 0.01), PSA density (OR 1.48 per 0.1 unit, 95% CI 1.33–1.64, p < 0.01), PI‐RADS score 4 (OR 3.28, 95% CI 2.21–4.87, p < 0.01), and PI‐RADS score 5 (OR 7.65, 95% CI 4.93–11.85, p < 0.01). Area under ROC curve was 82% for nomogram compared to 75% for PI‐RADS score alone.ConclusionWe report a nomogram that combines PI‐RADS score with other clinical parameters. The nomogram outperforms PI‐RADS score for the detection of CS prostate cancer.