Reducing the demand for magnetic resonance imaging scans and prostate biopsies during the early detection of clinically significant prostate cancer: Applying the Barcelona risk-stratified pathway in Catalonia

Morote, Juan ; Borque-Fernando, Ángel (Universidad de Zaragoza) ; Esteban, Luis E. ; Picola, Natàlia ; Muñoz-Rodríguez, Jesús ; Paesano, Nahuel ; Ruiz-Plazas, Xavier ; Muñoz-Rivero, Marta V. ; Celma, Anna ; García-de Manuel, Gemma ; Miró, Berta ; Abascal, José M. ; Servian, Pol

Resumen: Purpose
To analyze the reduction in multiparametric magnetic resonance imaging (mpMRI) demand and prostate biopsies after the hypothetical implementation of the Barcelona risk-stratified pathway (BCN-RSP) in a population of the clinically significant prostate cancer (csCaP) early detection program in Catalonia.

Materials and Methods
A retrospective comparation between the hypothetical application of the BCN-RSP and the current pathway, which relied on pre-biopsy mpMRI and targeted and/or systematic biopsies, was conducted. The BCN-RSP stratify men with suspected CaP based on a prostate specific antigen (PSA) level >10 ng/ml and a suspicious rectal examination (DRE), and the Barcelona-risk calculator 1 (BCN-RC1) to avoid mpMRI scans. Subsequently, candidates for prostate biopsy following mpMRI are selected based on the BCN-RC2. This comparison involved 3,557 men with serum PSA levels > 3.0 ng/ml and/or suspicious DRE. The population was recruited prospectively in 10 centers from January 2021 and December 2022. CsCaP was defined when grade group ≥ 2.

Results
CsCaP was detected in 1,249 men (35.1%) and insignificant CaP was overdeteced in 498 (14%). The BCN-RSP would have avoid 705 mpMRI scans (19.8%), and 697 prostate biopsies (19.6%), while 61 csCaP (4.9%) would have been undetected. The overdetection of insignificant CaP would have decrease in 130 cases (26.1%), and the performance of prostate biopsy for csCaP detection would have increase to 41.5%.

Conclusion
The application of the BCN-RSP would reduce the demand for mpMRI scans and prostate biopsies by one fifth while less than 5% of csCaP would remain undetected. The overdetection of insignificant CaP would decrease by more than one quarter and the performance of prostate biopsy for csCaP detection would increase to higher than 40%.

Idioma: Inglés

DOI: 10.1016/J.UROLONC.2023.09.020

Año: 2024

Publicado en: UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS 42, 4 (2024), 115.e1-115.e7
ISSN: 1078-1439

Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PI20/01666

Tipo y forma: Article (Published version)

Área (Departamento): Área Urología (Dpto. Cirugía)