Assessment of a urinary TRUS/biomarker-based risk score as inclusion criteria for multiparametric MRI to detect clinically significant prostate cancer

Trooskens G et al. Abs. 66. Presented at the Global Congress on Prostate Cancer (PROSCA) 2018; available at :


What was studied?

This study assessed if SelectMDx combined with information from a transrectal ultrasound (TRUS) could be used to exclude men with a low possibility of having high-risk prostate cancer (PCa) from undergoing multiparametric (mp)MRI.


What were the main outcomes?

Based on SelectMDx + TRUS, 50 out of 144 men (35%) were classified as having a low possibility of high-grade PCa. These men underwent mpMRI and 22% (11/50) had PI-RADS 4 or 5. On biopsy, PCa (Prostate Gleason Grade [PGG]/ISUP grade 2) was found in only 1 man; no PGG/ISUP grade ≥3 were missed.

The remaining 94 of 144 men (62%) were classified by SelectMDx + TRUS as having a high possibility of high-grade PCa. Of these 80% (75/94) had a PI-RADS 4 or 5 on mpMRI. The biopsy found PCa with an PGG/ISUP grade ≥2 in 64% (48/75) of these men of which 54% (26/48) were PGG/ISUP grade ≥3.

If SelectMDx + TRUS would be used as a selection tool for mpMRI, 1 PCa with PGG/ISUP grade 2 (0.7%) and no PGG/ISUP grade ≥3 PCa would be missed.

SelectMDx avoided 51% (49/94)of unnecessary mpMRIs in healthy and non-significant PCa (PGG/ISUP grade 1) patients and 35% of all MRIs in this cohort.


Figure. Results if SelectMDx combined with TRUS information would be used as an exclusion criteria for mpMRI

Assessment of urinary TRUS/biomarker-based risk score

MRI+: PI-RADS grade 4 or 5
ISUP: International Society of Urological Pathology


What was concluded?

SelectMDx combined with TRUS information before mpMRI may result in a significant reduction of unnecessary mpMRIs and biopsies . In this study no PGG/ISUP grade ≥3 PCa were missed. The authors recommend to perform SelectMDx as an exclusion criteria for mpMRI.


How was the study performed?

The study included 144 men from the SelectMDx validation study1. These men received a mpMRI and TRUS on their first biopsy. For these men the SelectMDx risk score combined with information from TRUS, and PI-RADS grades were assessed.

  1. Van Neste L et al. Eur Urol 2016;70:740-8

Editor comment

The overall costs for the healthcare system are rising every year and in patients with an elevated PSA this is mainly due to patients undergoing mpMRI. In this study they assessed that SelectMDx + information from a TRUS could be used to exclude 50/144 men from undergoing a mpMRI while missing 1 Gleason score 3+4=7 PCa and no Gleason score 8 or higher PCa, therefore lowering healthcare costs.

Photo Dr. Inge van Oort
Dr. Inge van Oort
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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