Neoplasia, Cancer, Outcomes analysis, Observer performance, Diagnostic procedure, MR, Pelvis, Oncology, Genital / Reproductive system male
J. Ash-Miles, H. M. A. OBrien, P. Charters, S. HALDAR; Bristol/UK
In our tertiary referral centre,
the outcomes for patients presenting with an elevated PSA correlate favorably with the results from the PROMIS trial.
- PROMIS suggested that 27% of patients can safely avoid a biopsy. In our centre 123 of 270 men were allocated PIRADS 1 or 2 and 90 (33%) did not undergo biopsy.
- PROMIS demonstrated that 11% (17/158) of men with a negative MP-MRI had clinically significant cancer on biopsy.
In our centre,
123 patients were allocated PIRADS 1 & 2.
Of the 33 that had biopsy,
cancer was found in 9 (27%).
This figure is high because in PROMIS all patients underwent biopsy.
In our practice,
select 1 & 2 patients would only have biopsy if there is high PSA density (greater than 0.15,
positive family history or other clinical concern).
- The PROMIS trial demonstrated a positive predictive value of 51% for primary definition clinically significant cancer.
In our centre,
31 (42%) of the 73 biopsied men with PIRADS 4 or 5 had clinically significant cancer.
37 (51%) were secondary definition clinically significant cancer compared to PROMIS 69%.
- PROMIS demonstrated negative predictive value of 89%.
Our centre demonstrated a negative predictive value of 73% (24 of the 33 PIRADS 1 or 2 who were biopsied).
- PROMIS demonstrated that 21% of PIRADS 3 men demonstrated clinically significant cancer.
Our centre demonstrated that 13 of the 70 PIRADS 3 men (19%) had clinically significant cancer.
- PROMIS demonstrated a false positive rate for PIRADS 4 and 5 of 18% (76/418).
Our centre demonstrated a false positive rate of 22% with causes including inflammation,
high grade PIN and suspicious but not diagnostic findings.
The PROMIS data relates to a selective patient group. The data translates favourable and safely to a tertiary unit managing non-selective patients.
Implementation of the PROMIS trial has led to a much improved service for patients at our centre.