PD65-10 URINARY MYPROSTATESCORE (MPS) TO RULE OUT CLINICALLY-SIGNIFICANT CANCER IN MEN WITH EQUIVOCAL (PI-RADS 3) MULTIPARAMETRIC MRI: ADDRESSING AN UNMET CLINICAL NEED (2021)

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII (PD65)1 Sep 2021PD65-10 URINARY MYPROSTATESCORE (MPS) TO RULE OUT CLINICALLY-SIGNIFICANT CANCER IN MEN WITH EQUIVOCAL (PI-RADS 3) MULTIPARAMETRIC MRI: ADDRESSING AN UNMET CLINICAL NEED Udit Singhal, Jeffrey Tosoian, Matthew Davenport, John Wei, Jeffrey Montgomery, Arvin George, Simpa Salami, Stanley Mukundi, Javed Siddiqui, Lakshmi Kunju, Benjamin Tooke, Yoonhee Ryder, Sarah Dugan, Zoey Chopra, Rachel Botbyl, Yilin Feng, Michael Sessine, Nicholas Eyrich, Ashley Ross, Bruce Trock, Scott Tomlins, Ganesh Palapattu, Arul Chinnaiyan, Yashar Niknafs, and Todd Morgan Udit SinghalUdit Singhal More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Matthew DavenportMatthew Davenport More articles by this author , John WeiJohn Wei More articles by this author , Jeffrey MontgomeryJeffrey Montgomery More articles by this author , Arvin GeorgeArvin George More articles by this author , Simpa SalamiSimpa Salami More articles by this author , Stanley MukundiStanley Mukundi More articles by this author , Javed SiddiquiJaved Siddiqui More articles by this author , Lakshmi KunjuLakshmi Kunju More articles by this author , Benjamin TookeBenjamin Tooke More articles by this author , Yoonhee RyderYoonhee Ryder More articles by this author , Sarah DuganSarah Dugan More articles by this author , Zoey ChopraZoey Chopra More articles by this author , Rachel BotbylRachel Botbyl More articles by this author , Yilin FengYilin Feng More articles by this author , Michael SessineMichael Sessine More articles by this author , Nicholas EyrichNicholas Eyrich More articles by this author , Ashley RossAshley Ross More articles by this author , Bruce TrockBruce Trock More articles by this author , Scott TomlinsScott Tomlins More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , Arul ChinnaiyanArul Chinnaiyan More articles by this author , Yashar NiknafsYashar Niknafs More articles by this author , and Todd MorganTodd Morgan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002109.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the complementary value of urinary MyProstateScore (MPS) testing and multiparametric MRI (mpMRI) and compare clinical outcomes based on application of MPS and PSA density (PSAD) in patients with equivocal (PI-RADS 3) mpMRI. METHODS: We included patients that underwent mpMRI followed by urine collection and prostate biopsy at the University of Michigan between 2015-2019. mpMRI was evaluated at the patient-level according to the maximum Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score. MPS values were retrospectively calculated from whole urine specimens using the validated locked model based on serum PSA, urinary PCA3, and urinary TMPRSS2:ERG expression. In the PI-RADS 3 population, the discriminative accuracy of PSA, PSAD, and MPS for GG≥2 cancer was quantified by the area under the receiver operating characteristic curve (AUC). Decision curve analysis was used to assess net benefit of MPS testing relative to PSAD. RESULTS: There were 540 patients that underwent mpMRI and prostate biopsy with valid urinary MPS results. The prevalence of GG≥2 cancer was 13% for PI-RADS 3, 56% for PI-RADS 4, and 87% for PI-RADS 5. MPS was significantly higher in men with GG≥2 cancer [median 44.9, IQR (29.4-57.5)] than those with negative or GG1 biopsy [median 29.2, IQR (14.8-44.2); p<0.001]. This was true overall and within each PI-RADS score. In the PI-RADS 3 population (n=121), the AUC for predicting GG≥2 cancer was 0.55 for PSA, 0.62 for PSAD, and 0.73 for MPS. On decision curve analysis, MPS provided the highest net clinical benefit across all pertinent threshold probabilities. Use of a MPS threshold ≤25 for risk-stratification would have prevented nearly 40% of biopsies while missing only one GG≥2 cancer. CONCLUSIONS: In this institutional cohort of patients that underwent mpMRI and prostate biopsy, urinary MPS was significantly associated with GG≥2 cancer across all PI-RADS scores, suggesting a potential additive role of these diagnostic tools. In men with PI-RADS 3 observations, MPS values ≤25 ruled out GG≥2 cancer with high negative predictive value, significantly outperforming PSAD. Source of Funding: JJT was supported by the National Institutes of Health/National Cancer Institute Advanced Training in Urologic Oncology Grant (T32/CA180984). His research is funded in part by a University of Michigan Precision Health Research Scholar Award and the SPORE Career Enhancement Program (CA186786). TMM is supported by the A. Alfred Taubman Medical Research Institute. AMC is a Howard Hughes Medical Institute Investigator and an American Cancer Society Research Professor. This work was supported by the Prostate Cancer Foundation, NCI Prostate SPORE (P50 CA186786), an NCI Outstanding Investigator Award (R35CA231996), and an NCI Early Detection Research Network U01 (5U01CA214170-04) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1156-e1156 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Udit Singhal More articles by this author Jeffrey Tosoian More articles by this author Matthew Davenport More articles by this author John Wei More articles by this author Jeffrey Montgomery More articles by this author Arvin George More articles by this author Simpa Salami More articles by this author Stanley Mukundi More articles by this author Javed Siddiqui More articles by this author Lakshmi Kunju More articles by this author Benjamin Tooke More articles by this author Yoonhee Ryder More articles by this author Sarah Dugan More articles by this author Zoey Chopra More articles by this author Rachel Botbyl More articles by this author Yilin Feng More articles by this author Michael Sessine More articles by this author Nicholas Eyrich More articles by this author Ashley Ross More articles by this author Bruce Trock More articles by this author Scott Tomlins More articles by this author Ganesh Palapattu More articles by this author Arul Chinnaiyan More articles by this author Yashar Niknafs More articles by this author Todd Morgan More articles by this author Expand All Advertisement PDF downloadLoading ...