Value of Magnetic Resonance Imaging Compared With Urine-Based Markers in the Detection of Prostate Cancer

Abstract

Urine and serum biomarkers have become increasingly adopted to aid in the risk stratification and diagnosis of prostate cancer, given that prostate-specific antigen (PSA) has a relatively low specificity for prostate cancer. A microsimulation model of prostate cancer progression and survival was recently used to compare the value of using different urine-based biomarkers and multiparametric magnetic resonance imaging (mpMRI) as reflex tests in men with elevated PSA. The authors characterize mpMRI as a reflex test within this study, which underestimates and devalues its utility. The value of mpMRI begins with an accurate assessment of prostate volume, which can be used to calculate PSA density (PSAD). Using prospective, multi-institutional trial data from the 4Kscore, PSAD predicted clinically significant prostate cancer better than PSA alone for increasing values of PSA. The area under the receiver operating characteristic curve (AUC) of PSAD was significantly greater than PSA in patients with significant prostate cancer in the PSA range of 4 to 10 ng/mL (AUC 0.72 vs 0.57, P<.0001) and PSA >10 ng/mL (AUC 0.82 vs 0.68, P<.0001). Although PSAD is an important piece of information obtained from mpMRI, its primary utility is its ability to visualize prostate lesions that harbor the most clinically significant cancer within the gland.

Authors

Joshua S. Jue Javier González Mahmoud Alameddine

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