Urinary MyProstateScore (MPS) to Rule out Clinically-Significant Cancer in Men with Equivocal (PI-RADS 3) Multiparametric MRI: Addressing an Unmet Clinical Need

Jeffrey J Tosoian; Udit Singhal; Matthew S Davenport; John T Wei; Jeffrey S Montgomery; Arvin K George; Simpa S Salami; Stanley G Mukundi; Javed Siddiqui; Lakshmi P Kunju; Benjamin P Tooke; C Yoonhee Ryder; Sarah P Dugan; Zoey Chopra; Rachel Botbyl; Yilin Feng; Michael S Sessine; Nicholas W Eyrich; Ashley E Ross; Bruce J Trock; Scott A Tomlins; Ganesh S Palapattu; Arul M Chinnaiyan; Yashar S Niknafs; Todd M Morgan

doi:10.1016/j.urology.2021.11.033

Urinary MyProstateScore (MPS) to Rule out Clinically-Significant Cancer in Men with Equivocal (PI-RADS 3) Multiparametric MRI: Addressing an Unmet Clinical Need

Urology. 2022 Jun:164:184-190. doi: 10.1016/j.urology.2021.11.033. Epub 2021 Dec 11.

Authors

Jeffrey J Tosoian¹, Udit Singhal², Matthew S Davenport³, John T Wei⁴, Jeffrey S Montgomery⁵, Arvin K George⁵, Simpa S Salami⁵, Stanley G Mukundi⁴, Javed Siddiqui⁶, Lakshmi P Kunju⁷, Benjamin P Tooke⁸, C Yoonhee Ryder⁸, Sarah P Dugan⁸, Zoey Chopra⁸, Rachel Botbyl⁶, Yilin Feng⁸, Michael S Sessine⁹, Nicholas W Eyrich¹⁰, Ashley E Ross¹¹, Bruce J Trock¹², Scott A Tomlins¹³, Ganesh S Palapattu¹⁴, Arul M Chinnaiyan¹⁵, Yashar S Niknafs⁶, Todd M Morgan⁵

Affiliations

¹ Department of Urology, Vanderbilt University, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN; Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI. Electronic address: [email protected].
² Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Department of Urology, Mayo Clinic, Rochester, MN.
³ Department of Urology, University of Michigan, Ann Arbor, MI; Department of Radiology, University of Michigan, Ann Arbor, MI.
⁴ Department of Urology, University of Michigan, Ann Arbor, MI.
⁵ Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI.
⁶ Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI.
⁷ Department of Pathology, University of Michigan, Ann Arbor, MI.
⁸ University of Michigan Medical School, Ann Arbor, MI.
⁹ Department of Urology, Wayne State University, Detroit, MI.
¹⁰ Department of Urology, Emory University, Atlanta, GA.
¹¹ Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL.
¹² Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD.
¹³ Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI.
¹⁴ Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Department of Urology, Medical University of Vienna, Vienna, Austria.
¹⁵ Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI; Department of Pathology, University of Michigan, Ann Arbor, MI; Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI.

Abstract

Objective: To evaluate the complementary value of urinary MyProstateScore (MPS) testing and multiparametric MRI (mpMRI) and assess outcomes in patients with equivocal mpMRI.

Materials and methods: Included patients underwent mpMRI followed by urine collection and prostate biopsy at the University of Michigan between 2015 -2019. MPS values were calculated from urine specimens using the validated model based on serum PSA, urinary PCA3, and urinary TMPRSS2:ERG. In the PI-RADS 3 population, the discriminative accuracy of PSA, PSAD, and MPS for GG≥2 cancer was quantified by the AUC curve. Decision curve analysis was used to assess net benefit of MPS relative to PSAD.

Results: There were 540 patients that underwent mpMRI and biopsy with MPS available. The prevalence of GG≥2 cancer was 13% for PI-RADS 3, 56% for PI-RADS 4, and 87% for PI-RADS 5. MPS was significantly higher in men with GG≥2 cancer [median 44.9, IQR (29.4 -57.5)] than those with negative or GG1 biopsy [median 29.2, IQR (14.8 -44.2); P <.001] in the overall population and when stratified by PI-RADS score. In the PI-RADS 3 population (n = 121), the AUC for predicting GG≥2 cancer was 0.55 for PSA, 0.62 for PSAD, and 0.73 for MPS. MPS provided the highest net clinical benefit across all pertinent threshold probabilities.

Conclusion: In patients that underwent mpMRI and biopsy, MPS was significantly associated with GG≥2 cancer across all PI-RADS scores. In the PI-RADS 3 population, MPS significantly outperformed PSAD in ruling out GG≥2 cancer. These findings suggest a complementary role of MPS testing in patients that have undergone mpMRI.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Humans
Magnetic Resonance Imaging
Male
Multiparametric Magnetic Resonance Imaging*
Prostate-Specific Antigen
Prostatic Neoplasms* / diagnostic imaging
Retrospective Studies

Substances

Prostate-Specific Antigen

Abstract

Publication types

MeSH terms

Substances

Grants and funding