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  • Title: Nomogram predicting prostate cancer in patients with negative prebiopsy multiparametric magnetic resonance.
    Author: Chen M, Wang R, Zhang T, Zhang X, Wan Y, Fu X.
    Journal: Future Oncol; 2022 Apr; 18(12):1473-1483. PubMed ID: 35105154.
    Abstract:
    Aim: To build two nomograms for predicting the possibilities of prostate cancer (PCa) and clinically significant PCa (csPCa) in patients with negative prebiopsy multiparametric MRI (mpMRI). Methods: The independent predictors associated with PCa or csPCa in patients with negative mpMRI were determined and served in the construction of the two nomograms. Results: The nomogram predicting PCa consisted of age, positive digital rectal examination, free/total prostate-specific antigen (PSA) ratio and PSA density, while age, positive digital rectal examination and PSA density comprised the nomogram predicting csPCa. The negative predictive value of mpMRI for PCa and csPCa improved from 77.1 and 87.5% to 90.4 and 96.1%, respectively, in the training cohort (n = 376) and from 81.9 and 89.0% to 91.8 and 96.5%, respectively, in the validation cohort (n = 127) when combined with the two nomograms. Conclusion: The negative predictive value of negative mpMRI for the detection of PCa or csPCa was improved with the results of the nomograms. When a patient has an elevated PSA level, a prostate biopsy is frequently required to diagnose prostate cancer (PCa). However, many men are not diagnosed with PCa or have indolent PCa, which means they are subjected to unnecessary biopsies that may lead to bleeding, pain and infection. With the development of multiparametric MRI (mpMRI), more biopsy-naive patients will undergo mpMRI to minimize unnecessary biopsies. Nonetheless, some patients with negative mpMRI findings but elevated levels of prostate-specific antigen still undergo prostate biopsies to rule out the possibility of MRI-invisible cancer, driving a potential for unnecessary biopsies. Therefore we developed two prediction models to estimate the likelihood of PCa and clinically significant PCa in patients with negative mpMRI, which may help to select optimal strategies to avoid unnecessary biopsies.
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