MultiParametric Magnetic Resonance Imaging-Based Nomogram for Predicting Prostate Cancer and Clinically Significant Prostate Cancer in Men Undergoing Repeat Prostate Biopsy

Figure 3

A 65-year-old patient with an elevated PSA of 8.58 ng/ml and a previous negative biopsy, which was diagnosed with a Gleason 4 + 3 = 7 prostate cancer on repeat biopsy. (a) Axial T2-weighted axial image showing a lesion of low T2 signal in the right mid peripheral zone. (b) Diffusion weighted imaging with b value of 1000 sec/mm2 confirming the lesion. (c) Apparent diffusion coefficient map shows a focal area of diffusion restriction, measuring 1.3 cm in the longest diameter (white arrow). The total PI-RADS version 2 score for the lesion was 4 according to both radiologists, which is suggestive of a high probability of prostate cancer. (d) Nomogram predicting probability of PCa for this patient. The corresponding points for the variables (age, 65 years = 38 points [black line]; PSA, 8.58 ng/ml = 18 points [pink line]; PV, 64.25 ml = 61 points [grey line]; DRE, abnormal = 28 points [blue line]; mpMRI, positive = 45 points [green line]) yielding a total of 190 points, which indicates the probability of having PCa is 0.60 [red line]. For a probability > 0.33 defined as being compatible with PCa, nomogram correctly predicted the presence of PCa. (e) Nomogram predicting probability of csPCa for this patient. Similarly, a total of 168 points showed that the probability of detecting csPCa is 0.50, greater than the cutoff of 0.21, which allowed correct prediction of the presence of csPCa.