Beyond Prostate Imaging Reporting and Data System: Combining Magnetic Resonance Imaging Prostate Imaging Reporting and Data System and Prostate-Specific Membrane Antigen-Positron Emission Tomography/Computed Tomography PRIMARY Score in a Composite (P) Score for More Accurate Diagnosis of Clinically Significant Prostate Cancer

Louise Emmett; Nathan Papa; Thomas A Hope; Wolfgang Fendler; Jeremie Calais; Irene Burger; Matthias Eiber; Francesco Barbato; Daniel Moon; William Counter; Nikeith John; Alan Xue; Anthony Franklin; James Thompson; Kris Rasiah; Mark Frydenberg; John Yaxley; James Buteau; Shikha Agrawal; Bao Ho; Andrew Nguyen; Victor Liu; Jonathan Lee; Henry Woo; Edward Hsiao; Thomas Sutherland; Elyse Perry; Phillip Stricker; Michael S Hofman; Veeru Kasivisvanathan; Matthew Roberts; Declan Murphy

doi:10.1097/JU.0000000000004010

Beyond Prostate Imaging Reporting and Data System: Combining Magnetic Resonance Imaging Prostate Imaging Reporting and Data System and Prostate-Specific Membrane Antigen-Positron Emission Tomography/Computed Tomography PRIMARY Score in a Composite (P) Score for More Accurate Diagnosis of Clinically Significant Prostate Cancer

J Urol. 2024 May 21:101097JU0000000000004010. doi: 10.1097/JU.0000000000004010. Online ahead of print.

Authors

Louise Emmett^{1

2

3}, Nathan Papa², Thomas A Hope⁴, Wolfgang Fendler⁵, Jeremie Calais⁶, Irene Burger⁷, Matthias Eiber⁸, Francesco Barbato⁵, Daniel Moon⁹, William Counter¹, Nikeith John^{1

3}, Alan Xue¹⁰, Anthony Franklin¹¹, James Thompson^{2

12}, Kris Rasiah¹³, Mark Frydenberg¹⁰, John Yaxley¹⁴, James Buteau¹⁵, Shikha Agrawal^{1

2}, Bao Ho¹, Andrew Nguyen¹, Victor Liu¹, Jonathan Lee¹, Henry Woo¹⁶, Edward Hsiao¹⁶, Thomas Sutherland¹⁷, Elyse Perry¹⁷, Phillip Stricker¹², Michael S Hofman^{15

18}, Veeru Kasivisvanathan¹⁹, Matthew Roberts⁵, Declan Murphy⁹

Affiliations

¹ Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, Australia.
² Garvan Institute of Medical Research, Sydney, Australia.
³ St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
⁴ Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
⁵ Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)- University Hospital Essen, Essen, Germany.
⁶ Ahmanson Translational Theranostics, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California.
⁷ Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
⁸ Department of Nuclear Medicine, School of Medicine, Technical University Munich, Munich, Germany.
⁹ Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹⁰ Department of Surgery, Faculty of Medicine, Monash University.
¹¹ Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
¹² Department of Urology, St Vincent's Hospital Sydney.
¹³ Royal North Shore Hospital, Sydney, Australia.
¹⁴ The Wesley Hospital, Brisbane, Australia.
¹⁵ Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer, Melbourne, Australia.
¹⁶ Department of Uro-Oncology, Chris O'Brien Lifehouse, Sydney, Australia.
¹⁷ Department of Radiology, St Vincent's Hospital, Melbourne, Australia.
¹⁸ Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
¹⁹ Division of Surgery and Interventional Science, University College London, London, United Kingdom.

PMID: 38758680
DOI: 10.1097/JU.0000000000004010

Abstract

Purpose: The Prostate Imaging Reporting and Data System (PI-RADS) score is standard of care for clinically significant prostate cancer (csPCa) diagnosis. The PRIMARY score (prostate-specific membrane antigen [PSMA]-positron emission tomography [PET]/CT) also has high diagnostic accuracy for csPCa. This study aimed to develop an easily calculated combined (P) score for csPCa detection (International Society of Urological Pathology [ISUP] ≥2) incorporating separately read PI-RADS and PRIMARY scores, with external validation.

Materials and methods: Two datasets of men with suspected PCa, no prior biopsy, recent MRI and ⁶⁸Ga-PSMA-11-PET/CT, and subsequent transperineal biopsy were evaluated. The development sample (n = 291, 56% csPCa) a prospective trial and the validation sample (n = 227, 67% csPCa) a multicenter retrospective database. Primary outcome was detection of csPCa (ISUP ≥2), with ISUP ≥ 3 cancer detection a secondary outcome. Score performance was evaluated by area under the curve, sensitivity, specificity, and decision curve analysis.

Results: The 5-point combined (P) score was developed in a prospective dataset. In the validation dataset, csPCa was identified in 0%, 20%, 52%, 96%, and 100% for P score 1 to 5. The area under the curve was 0.93 (95% CI: 0.90-0.96), higher than PI-RADS 0.89 (95% CI: 0.85-0.93, P = .039) and PRIMARY score alone 0.84 (95% CI: 0.79-0.89, P < .001). Splitting scores at 1/2 (negative) vs 3/4/5 (positive), P score sensitivity was 94% (95% CI: 89-97) compared to PI-RADS 89% (95% CI: 83-93) and PRIMARY score 86% (95% CI: 79-91). For ISUP ≥ 3, P score sensitivity was 99% (95% CI: 95-100) vs 94% (95% CI: 88-98) and 92% (95% CI: 85-97) for PI-RADS and PRIMARY scores respectively. A maximum standardized uptake value > 12 (P score 5) was ISUP ≥ 2 in all cases with 93% ISUP ≥ 3.

Conclusions: The P score is easily calculated and improves accuracy for csPCa over both PI-RADS and PRIMARY scores. It should be considered when PSMA-PET is undertaken for diagnosis.

Keywords: PET; PSMA; diagnosis; multi-parametric MRI; prostate cancer; prostate specific membrane antigen.