Comparison of Rotterdam and Barcelona Magnetic Resonance Imaging Risk Calculators for Predicting Clinically Significant Prostate Cancer

Juan Morote; Ángel Borque-Fernando; Marina Triquell; Miriam Campistol; Pol Servian; José M Abascal; Jacques Planas; Olga Méndez; Luis M Esteban; Enrique Trilla

doi:10.1016/j.euros.2023.03.013

Comparison of Rotterdam and Barcelona Magnetic Resonance Imaging Risk Calculators for Predicting Clinically Significant Prostate Cancer

Eur Urol Open Sci. 2023 May 22:53:46-54. doi: 10.1016/j.euros.2023.03.013. eCollection 2023 Jul.

Authors

Juan Morote^{1

2}, Ángel Borque-Fernando³, Marina Triquell^{1

2}, Miriam Campistol^{1

2}, Pol Servian⁴, José M Abascal^{5

6}, Jacques Planas^{1

2}, Olga Méndez⁷, Luis M Esteban⁸, Enrique Trilla^{1

2}

Affiliations

¹ Department of Urology, Vall d́Hebron Hospital, Barcelona, Spain.
² Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain.
³ Department of Urology, Hospital Miguel Servet, IIS-Aragon, Zaragoza, Spain.
⁴ Department of Urology, Hospital Germans Trias I Pujol, Badalona, Spain.
⁵ Department of Urology, Parc de Salut Mar, Barcelona, Spain.
⁶ Department of Surgery, Universitat Pompeu Fabra, Badalona, Spain.
⁷ Biomedical Research in Urology Unit, Vall d́Hebron Research Institute, Barcelona, Spain.
⁸ Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, Universidad de Zaragoza, Zaragoza, Spain.

Abstract

Background: Magnetic resonance imaging (MRI)-based risk calculators (MRI-RCs) individualise the likelihood of clinically significant prostate cancer (csPCa) and improve candidate selection for prostate biopsy beyond the Prostate Imaging Reporting and Data System (PI-RADS).

Objective: To compare the Barcelona (BCN) and Rotterdam (ROT) MRI-RCs in an entire population and according to the PI-RADS categories.

Design setting and participants: A prospective comparison of BCN- and ROT-RC in 946 men with suspected prostate cancer in whom systematic biopsy was performed, as well as target biopsies of PI-RADS ≥3 lesions.

Outcome measurements and statistical analysis: Saved biopsies and undetected csPCa (grade group ≥2) were determined.

Results and limitations: The csPCa detection was 40.8%. The median risks of csPCa from BCN- and ROT-RC were, respectively, 67.1% and 25% in men with csPCa, whereas 10.5% and 3% in those without csPCa (p < 0.001). The areas under the curve were 0.856 and 0.844, respectively (p = 0.116). BCN-RC showed a higher net benefit and clinical utility over ROT-RC. Using appropriate thresholds, respectively, 75% and 80% of biopsies were needed to identify 50% of csPCa detected in men with PI-RADS <3, whereas 35% and 21% of biopsies were saved, missing 10% of csPCa detected in men with PI-RADS 3. BCN-RC saved 15% of biopsies, missing 2% of csPCa in men with PI-RADS 4, whereas ROT-RC saved 10%, missing 6%. No RC saved biopsies without missing csPCa in men with PI-RADS 5.

Conclusions: ROT-RC provided a lower and narrower range of csPCa probabilities than BCN-RC. BCN-RC showed a net benefit over ROT-RC in the entire population. However, BCN-RC was useful in men with PI-RADS 3 and 4, whereas ROT-RC was useful only in those with PI-RADS 3. No RC seemed to be helpful in men with negative MRI and PI-RADS 5.

Patient summary: Barcelona risk calculator was more helpful than Rotterdam risk calculator to select candidates for prostate biopsy.

Keywords: Clinically significant; Early detection; Magnetic resonance imaging; Predictive model; Prostate cancer; Risk calculator.