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. TrockScott A. Tomlins, Ganesh S. Palapattu, Arul M. Chinnaiyan, Yashar S. Niknafs, Todd M. Morgan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)184-190
Number of pages7
JournalUrology
Volume164
DOIs
StatePublished - Jun 2022

ASJC Scopus subject areas

  • Urology

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