Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, Australia.
Garvan Institute of Medical Research, Sydney, Australia.
J Urol. 2024 Aug;212(2):299-309. doi: 10.1097/JU.0000000000004010. Epub 2024 May 17.
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.
Two datasets of men with suspected PCa, no prior biopsy, recent MRI and Ga-PSMA-11-PET/CT, and subsequent transperineal biopsy were evaluated. These included 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.
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, = .039) and PRIMARY score alone 0.84 (95% CI: 0.79-0.89, < .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.
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.
前列腺影像报告和数据系统（PI-RADS）评分是临床显著前列腺癌（csPCa）诊断的标准。原发性评分（前列腺特异性膜抗原[PSMA]-正电子发射断层扫描[PET]/CT）对于 csPCa 也具有较高的诊断准确性。本研究旨在开发一种易于计算的联合（P）评分，用于检测 csPCa（国际泌尿病理学会[ISUP]≥2），该评分结合了分别读取的 PI-RADS 和 PRIMARY 评分，并进行了外部验证。
评估了两组疑似前列腺癌、无既往活检、近期 MRI 和 Ga-PSMA-11-PET/CT 以及随后经会阴活检的男性患者。这些包括开发样本（n=291，56% csPCa）和前瞻性试验以及验证样本（n=227，67% csPCa）的多中心回顾性数据库。主要结局是检测 csPCa（ISUP≥2），次要结局是检测 ISUP≥3 癌症。通过曲线下面积、敏感性、特异性和决策曲线分析评估评分性能。
5 分联合（P）评分在前瞻性数据集开发。在验证数据集，P 评分 1 至 5 时，csPCa 的检出率分别为 0%、20%、52%、96%和 100%。曲线下面积为 0.93（95%CI：0.90-0.96），高于 PI-RADS 0.89（95%CI：0.85-0.93， =.039）和原发性评分 0.84（95%CI：0.79-0.89， <.001）。将评分分为 1/2（阴性）与 3/4/5（阳性），P 评分的敏感性为 94%（95%CI：89-97），而 PI-RADS 为 89%（95%CI：83-93）和原发性评分 86%（95%CI：79-91）。对于 ISUP≥3，P 评分的敏感性为 99%（95%CI：95-100），而 PI-RADS 和原发性评分的敏感性分别为 94%（95%CI：88-98）和 92%（95%CI：85-97）。最大标准化摄取值>12（P 评分 5）时，所有病例均为 ISUP≥2，其中 93%的病例为 ISUP≥3。
P 评分易于计算，与 PI-RADS 和 PRIMARY 评分相比，可提高 csPCa 的准确性。当进行 PSMA-PET 诊断时，应考虑使用该评分。
