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Accuracy of Radionics to Diagnose Progression of Prostate Cancer in Patients Undergoing Active Surveillance: A Systematic Review and Diagnostic Meta-Analysis
Thaise Sestelo Uzeda, MD1, Mohammed Abdullah Ramadhan, MBChB2, Giovanni B. Torri, MD3, Giulia Almiron da R. Soares, MD4, Lucas G. C. R. de Amorim, MD5, Giovana Veiga Gomes, .6, Guilherme Melchior Maia Lopes, .7, Manuel Guillermo Ruelas Martinez, MD8, Vinay Anant Duddalwar, MD9, André Luis de Castro Abreu, MD9, Barbara Vieira Lima Aguiar Melão, MD, PhD10.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Jaber Al Ahmed Al Sabah Hospital, Kuwait City, Kuwait, 3University of Florida, Miami, FL, USA, 4Universidade Metropolitana de Santos, Santos, Brazil, 5Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, 6Universidade Municipal de São Caetano do Sul, São Caetano do Sul, Brazil, 7FMABC, Santo André, Brazil, 8Tecnologico de Monterrey, Monterrey, Mexico, 9University of Southern California, Los Angeles, CA, USA, 10University of São Paulo, São Paulo, Brazil.
BACKGROUND: Active surveillance (AS) is a standard approach for men with low-risk prostate cancer (PCa) to avoid overtreatment while preserving quality of life. Monitoring progression remains challenging due to disease heterogeneity. This review aimed to evaluate the diagnostic accuracy of MRI-based radiomics in predicting progression in patients undergoing AS.
METHODS: A systematic search of PubMed, Embase, and Cochrane Library was conducted from database inception to January 30th, 2026. Studies assessing radiomics for PCa progression in AS were included. Study quality was assessed using QUADAS-2 and methodological quality was assessed using RQS. Diagnostic meta-analysis was performed calculating sensitivity, specificity, accuracy, odds ratio (OR), and predictive values. Delta radiomics and combinations with clinical parameters such as prostate-specific antigen density (PSAd) were also analyzed. The study protocol was prospectively registered on PROSPERO [CRD42024566350].
RESULTS: Nine studies including 1113 patients were analyzed. Radiomics alone predicted progression with accuracy 0.71, sensitivity 0.87, specificity 0.58, PPV 0.62, and NPV 0.85 (OR 3.24). Delta radiomics combined with PSAd improved accuracy to 0.75, sensitivity 0.85, specificity 0.66, PPV 0.71, and NPV 0.81 (OR 3.21), showing the best performance in our analysis. Delta radiomics alone showed similar results, with accuracy of 0.73, sensitivity of 0.89, specificity 0.61, and OR 3.84. Limitations include moderate heterogeneity and variability across study protocols.
CONCLUSIONS: Radiomics, alone or combined with clinical parameters, reliably predicts progression in AS patients and may reduce unnecessary biopsies while maintaining high sensitivity and NPV.
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