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dc.contributor.authorStavrinides, V
dc.contributor.authorSyer, T
dc.contributor.authorHu, Y
dc.contributor.authorGiganti, F
dc.contributor.authorFreeman, A
dc.contributor.authorKarapanagiotis, S
dc.contributor.authorBott, SRJ
dc.contributor.authorBrown, LC
dc.contributor.authorBurns-Cox, N
dc.contributor.authorDudderidge, TJ
dc.contributor.authorBosaily, AE-S
dc.contributor.authorFrangou, E
dc.contributor.authorGhei, M
dc.contributor.authorHenderson, A
dc.contributor.authorHindley, RG
dc.contributor.authorKaplan, RS
dc.contributor.authorOldroyd, R
dc.contributor.authorParker, C
dc.contributor.authorPersad, R
dc.contributor.authorRosario, DJ
dc.contributor.authorShergill, IS
dc.contributor.authorEcheverria, LMC
dc.contributor.authorNorris, JM
dc.contributor.authorWinkler, M
dc.contributor.authorBarratt, D
dc.contributor.authorKirkham, A
dc.contributor.authorPunwani, S
dc.contributor.authorWhitaker, HC
dc.contributor.authorAhmed, HU
dc.contributor.authorEmberton, M
dc.contributor.authorPROMIS group
dc.date.accessioned2021-03-01T14:19:48Z
dc.date.available2021-03-01T14:19:48Z
dc.identifier.citationEuropean urology, 2021, 79 (1), pp. 20 - 29en_US
dc.identifier.issn0302-2838
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/4375
dc.identifier.eissn1873-7560en_US
dc.identifier.eissn1873-7560
dc.identifier.doi10.1016/j.eururo.2020.09.043en_US
dc.identifier.doi10.1016/j.eururo.2020.09.043
dc.description.abstract<h4>Background</h4>False positive multiparametric magnetic resonance imaging (mpMRI) phenotypes prompt unnecessary biopsies. The Prostate MRI Imaging Study (PROMIS) provides a unique opportunity to explore such phenotypes in biopsy-naïve men with raised prostate-specific antigen (PSA) and suspected cancer.<h4>Objective</h4>To compare mpMRI lesions in men with/without significant cancer on transperineal mapping biopsy (TPM).<h4>Design, setting, and participants</h4>PROMIS participants (n=235) underwent mpMRI followed by a combined biopsy procedure at University College London Hospital, including 5-mm TPM as the reference standard. Patients were divided into four mutually exclusive groups according to TPM findings: (1) no cancer, (2) insignificant cancer, (3) definition 2 significant cancer (Gleason ≥3+4 of any length and/or maximum cancer core length ≥4mm of any grade), and (4) definition 1 significant cancer (Gleason ≥4+3 of any length and/or maximum cancer core length ≥6mm of any grade).<h4>Outcome measurements and statistical analysis</h4>Index and/or additional lesions present in 178 participants were compared between TPM groups in terms of number, conspicuity, volume, location, and radiological characteristics.<h4>Results and limitations</h4>Most lesions were located in the peripheral zone. More men with significant cancer had two or more lesions than those without significant disease (67% vs 37%; p< 0.001). In the former group, index lesions were larger (mean volume 0.68 vs 0.50 ml; p< 0.001, Wilcoxon test), more conspicuous (Likert 4-5: 79% vs 22%; p< 0.001), and diffusion restricted (mean apparent diffusion coefficient [ADC]: 0.73 vs 0.86; p< 0.001, Wilcoxon test). In men with Likert 3 index lesions, log<sub>2</sub>PSA density and index lesion ADC were significant predictors of definition 1/2 disease in a logistic regression model (mean cross-validated area under the receiver-operator characteristic curve: 0.77 [95% confidence interval: 0.67-0.87]).<h4>Conclusions</h4>Significant cancer-associated MRI lesions in biopsy-naïve men have clinical-radiological differences, with lesions seen in prostates without significant disease. MRI-calculated PSA density and ADC could predict significant cancer in those with indeterminate MRI phenotypes.<h4>Patient summary</h4>Magnetic resonance imaging (MRI) lesions that mimic prostate cancer but are, in fact, benign prompt unnecessary biopsies in thousands of men with raised prostate-specific antigen. In this study we found that, on closer look, such false positive lesions have different features from cancerous ones. This means that doctors could potentially develop better tools to identify cancer on MRI and spare some patients from unnecessary biopsies.en_US
dc.formatPrint-Electronicen_US
dc.format.extent20 - 29en_US
dc.languageengen_US
dc.language.isoengen_US
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.subjectPROMIS groupen_US
dc.titleFalse Positive Multiparametric Magnetic Resonance Imaging Phenotypes in the Biopsy-naïve Prostate: Are They Distinct from Significant Cancer-associated Lesions? Lessons from PROMIS.en_US
dc.typeJournal Article
dcterms.dateAccepted2020-09-21
rioxxterms.versionAMen_US
rioxxterms.versionofrecord10.1016/j.eururo.2020.09.043en_US
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0en_US
dc.relation.isPartOfEuropean urologyen_US
pubs.issue1en_US
pubs.notesNot knownen_US
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublisheden_US
pubs.volume79en_US
pubs.embargo.termsNot knownen_US
dc.contributor.icrauthorParker, Chrisen_US


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