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Table 2 Diagnostic performance of diagnostic tests and uptake of subsequent biopsy

From: Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore

Diagnostic test Uptake True localized cancer status Diagnostic test findings Sources
mpMRI 100% No cancer • No suspicion of cancer or suspicion of low-risk cancer: 50%
• Suspicion of low-risk cancer: 17%
• Suspicion of intermediate or high-risk cancer: 50%
NICE, 2019; Brown et al., 2018
Low-risk cancer • No suspicion of cancer or suspicion of low-risk cancer: 44%
• Suspicion of low-risk cancer: 16%
• Suspicion of intermediate or high-risk cancer: 56%
Intermediate or high-risk cancer • No suspicion of cancer or suspicion of low-risk cancer: 13%
• Suspicion of low-risk cancer: 5%
• Suspicion of intermediate or high-risk cancer: 87%
First biopsy: systematic biopsy without prior mpMRI 100% Low-risk cancer • P (Low|Low): 35% Brown et al., 2018; Drost et al., 2019
Intermediate cancer • P (Low|Intermediate): 17%
• P (Intermediate|Intermediate): 59%
High-risk cancer • P (High|High): 100%
First biopsy: MRI targeted biopsy after a suspicious mpMRI result 100% Low-risk cancer • P (Low|Low): 35%
Intermediate cancer • P (Low|Intermediate): 8%
• P (Intermediate|Intermediate): 79%
High-risk cancer • P (High|High): 100%
Second biopsy: systematic biopsy following a negative systematic biopsy 71% Low-risk cancer • P (Low|Low): 45%
Intermediate cancer • P (Low|Intermediate): 10%
• P (Intermediate|Intermediate): 35%
High-risk cancer • P (High|High): -
Second biopsy MRI targeted biopsy following a suspicious mpMRI result and no cancer on prior systematic biopsy 71% Low-risk cancer • P (Low|Low): 45%
Intermediate cancer • P (Low|Intermediate): 6%
• P (Intermediate|Intermediate): 88%
High-risk cancer • P (High|High): -
Third biopsy: saturation biopsy 71% Low-risk cancer • Sensitivity: 95%
• Specificity: 100%
Expert opinion
Intermediate cancer • Sensitivity: 95%
• Specificity: 100%
High-risk cancer • Sensitivity: 95%
• Specificity: 100%
  1. Abbreviation: mpMRI multi-parametric magnetic resonance imaging
  2. Notes
  3. 1. MRI targeted biopsy refers to the administration of MRI targeted biopsy combined with systematic biopsy following a positive mpMRI.
  4. 2. P (Low|Low): probability of detecting low-risk cancer given that low-risk cancer exists; P (Low|Intermediate): probability of detecting low-risk cancer given that intermediate-risk cancer exists; P (Intermediate|Intermediate): probability of detecting intermediate-risk cancer given that intermediate-risk cancer exists; P(High|High): probability of detecting high-risk cancer given that high-risk cancer exists.
  5. 3. Estimated uptake rates were from surveyed clinician experts from public healthcare institutions.
  6. 4. From the surveyed clinician experts, based on the number of patients suspected of prostate cancer referred to public healthcare institutions for the first biopsy in the past five years, the estimated prevalence of prostate cancer in men referred for the first biopsy was 37.7%.
  7. 5. The uncertainty of model inputs was explored by simultaneously and randomly sampling the parameters from assigned distributions – beta distribution for health utilities values and multivariate normal distributions using Cholesky decomposition matrix for parameters characterizing disease progression.