Negative predictive value of prostate MRI in real world practice: Results from a statewide surgical collaborative in the United States

You have accessJournal of UrologyCME1 Apr 2023PD38-01 NEGATIVE PREDICTIVE VALUE OF PROSTATE MRI IN REAL WORLD PRACTICE: RESULTS FROM A STATEWIDE SURGICAL COLLABORATIVE Alex Zhu, Arnav Srivastava, John Michael DiBianco, Ji Qi, Apoorv Dhir, Mahir Maruf, Stephanie Ferrante, Anna Johnson, Alice Semerjian, Matthew S. Davenport, Leena Mammen, Ali Dabaja, Brian Lane, Kevin Ginsburg, Karla Witzke, Arvin K. George, and For the Michigan Urological Surgery Improvement Collaborative Alex ZhuAlex Zhu More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , John Michael DiBiancoJohn Michael DiBianco More articles by this author , Ji QiJi Qi More articles by this author , Apoorv DhirApoorv Dhir More articles by this author , Mahir MarufMahir Maruf More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Matthew S. DavenportMatthew S. Davenport More articles by this author , Leena MammenLeena Mammen More articles by this author , Ali DabajaAli Dabaja More articles by this author , Brian LaneBrian Lane More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , Karla WitzkeKarla Witzke More articles by this author , Arvin K. GeorgeArvin K. George More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The negative predictive value (NPV) for multi-parametric prostate magnetic resonance imaging (mpMRI) in the detection of clinically significant prostate cancer (csPCa) approaches 90%. Consequently, mpMRI has been proposed as a stratification and staging tool to detect csPCA while limiting unnecessary biopsies. However, wide variation exists in the application and interpretation of mpMRI. It remains to be seen if the high NPV published from expert centers remains reproducible and generalizable. We aimed to determine the real-world NPV of mpMRI across diverse practices in the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODS: The MUSIC clinical registry was used to determine the NPV for mpMRI in the detection of csPCa, defined as Grade Group (GG)≥2 PCa. We identified patients between 7/2016–7/2022 with negative mpMRI, defined as an absence of PI-RADS 3-5 lesions, who underwent biopsy within 1 year. Patients were classified into 2 groups: (1) biopsy naïve and (2) active surveillance (AS). NPV of MRI was summarized overall and for each subgroup. Multivariable logistic regression identified factors associated with csPCa. RESULTS: 857 patients who underwent 871 biopsies within 1 year of negative mpMRI were identified across 26 practices. 439 biopsies were performed in the biopsy naïve setting, and 432 while on AS. Median age was 65 years (IQR 60-69) and median PSA was 5.6 ng/dl (IQR 4.1-8.1). The NPV of prostate MRI for ≥GG2 PCa in biopsy-naïve patients, those undergoing AS, and the entire cohort was 80%, 75%, and 77%, respectively. On multivariable analysis, PSA density ≥0.1 was associated with higher risk of having csPCa diagnosis after negative MRI (OR 5.1 [95% CI 3.22-8.01], p<0.001). CONCLUSIONS: Across diverse urologic practices, the NPV of prostate MRI is 77%, lower than previously reported. Real-world data suggests that approximately 25% of men may miss a diagnosis of csPCA, most commonly GG2, if they do not undergo biopsy with a negative MRI. This likely represents limitations with current mpMRI implementation, and an opportunity to more accurately identify which patients should undergo biopsy, despite negative mpMRI findings. PSA density ≥0.1 should be utilized as a stratification tool for pursuing prostate biopsy after a negative mpMRI. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e993 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Zhu More articles by this author Arnav Srivastava More articles by this author John Michael DiBianco More articles by this author Ji Qi More articles by this author Apoorv Dhir More articles by this author Mahir Maruf More articles by this author Stephanie Ferrante More articles by this author Anna Johnson More articles by this author Alice Semerjian More articles by this author Matthew S. Davenport More articles by this author Leena Mammen More articles by this author Ali Dabaja More articles by this author Brian Lane More articles by this author Kevin Ginsburg More articles by this author Karla Witzke More articles by this author Arvin K. George More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...