External validation of the P-Score in the prospective, pre-biopsy DEPROMP cohort: integrated mpMRI and PSMA PET/CT risk stratification for prostate cancer detection.

purposeThis study aimed to externally validate the P-Score, a composite scoring system combining PI-RADS and PRIMARY score, for its diagnostic accuracy in detecting clinically significant (ISUP ≥ 2) and higher-grade (ISUP ≥ 3) prostate cancer (PCa).

methods230 biopsy-naïve men with suspected PCa were prospectively enrolled in the DEPROMP trial and underwent multiparametric MRI and [

resultsFor clinically significant PCa (ISUP ≥ 2), no significant difference in diagnostic performance was observed between the P-Score (AUC 0.796) and PI-RADS (AUC 0.804; p = 0.72), whereas the P-Score significantly outperformed the PRIMARY score (AUC 0.730; p < 0.001). Similarly, for detection of ISUP ≥ 3 disease, no significant difference in diagnostic performance was observed between the P-Score (AUC 0.840) and PI-RADS (AUC 0.830; p = 0.66). In the PI-RADS 3 subgroup, diagnostic performance remained limited, with AUCs of 0.573 (95% CI: 0.407-0.739) for the P-Score and 0.556 (95% CI: 0.389-0.722) for the PRIMARY score. Overall, the P-Score demonstrated robust diagnostic performance across disease categories and showed comparable accuracy to PI-RADS.

conclusionThe P-Score demonstrated diagnostic performance comparable to PI-RADS in this external validation cohort. While providing a standardized framework integrating anatomical and molecular imaging findings, further studies are warranted to determine whether it has a role in selected clinical scenarios and prospective research settings.