Dataset Information

PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?

ABSTRACT:

Objective

In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, "PI-RADS 5 patients").

Materials and methods

PI-RADS 5 patients who underwent MRI/Ultrasound fusion biopsy (Bx) between 2016 and 2020 were identified in our institutional database. Uni- and multivariable logistic-regression models were used to identify predictors of csPCA-detection (GGG ≥ 2). Risk models were adjusted for ECE, PSA-D, and cT-stage. Corresponding Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were calculated.

Results

Among 493 consecutive PI-RADS 5 patients, the median age and PSA was 69 years (IQR 63-74) and 8.9 ng/ml (IQR 6.0-13.7), respectively. CsPCA (GGG ≥ 2) was detected in 405/493 (82%); 36/493 patients (7%) had no cancer. When tabulating for PSA-D of > 0.2 ng/ml/cc and > 0.5 ng/ml/cc, csPCA was found in 228/253 (90%, PI-RADS5 + PSA-D > 0.2 ng/ml/cc) and 54/54 (100%, PI-RADS5 + PSA-D > 0.5 ng/ml/cc). Finally, a model incorporating PSA-D and cT-stage achieved an AUC of 0.79 (CI 0.74-0.83).

Conclusion

In PI-RADS 5 patients, PSA-D and cT-stage emerged as strong predictors of csPCA at biopsy. Moreover, when adding the threshold of PSA-D > 0,5 ng/ml/cc, all PI-RADS 5 patients were diagnosed with csPCA. Therefore, straight treatment for PCA can be considered, especially if risk-factors for biopsy-related complications such as obligatory dual platelet inhibition are present.

SUBMITTER: Falkenbach F

PROVIDER: S-EPMC10955031 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Publications

PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?

Falkenbach Fabian F Ambrosini Francesca F Kachanov Mykyta M Ortner Gernot G Maurer Tobias T Köhler Daniel D Beyersdorff Dirk D Graefen Markus M Budäus Lars L

World journal of urology 20240320 1

<h4>Objective</h4>In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, "PI-RADS 5 patients").<h4>Materials and methods</h4>PI-RADS 5 patients who underwent MRI/Ultras ...[more]

PMID: 38506941

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Project description:BackgroundProstate Imaging Reporting and Data System version 2 (PI-RADS V2) 3 category lesions are of intermediate status with an equivocal risk of presenting clinically significant prostate cancer (csPCa). How to avoid excessive biopsies while improving the csPCa detection rate in these lesions has always been a clinical problem that needed to be solved. The purpose of this study is to explore the csPCa diagnostic value of clinical and magnetic resonance imaging (MRI) data for peripheral and transitional zone (PZ and TZ, respectively) PI-RADS 3 lesions to aid in clinical decision-making and reduce excessive biopsies.MethodsFrom March 2016 to October 2018, a total of 629 men who underwent a prostate MRI and subsequently biopsy were enrolled. Two radiologists (with 3 and 7 years of experience, respectively) independently reviewed and scored all images using the PI-RADS V2 scoring criteria. Clinical and MRI data of men with PI-RADS 3 index lesions were collected by another radiologist. Univariate and multivariate analyses were performed to identify the risk factors of csPCa.ResultsIn a subset of 121 men with 121 PI-RADS 3 index lesions, 25.6% of the lesions (31/121) were PCa (Gleason score ≥6), and 11.6% (14/121) were csPCa (Gleason score ≥7). Further, 44.6% of lesions (54/121) were located in the PZ and 55.4% (67/121) in the TZ. For PZ lesions, 18.5% of the lesions (10/54) were csPCa. Prostate-specific antigen density (PSAD) (P=0.024) and age (P=0.026) were independent risk factors for csPCa in the multivariate logistic analysis. The combination of PSAD and age yielded an area under the curve (AUC) value of 0.816 for predicting csPCa. If biopsy had been restricted to patients with a PSAD ≥0.15 ng/mL2 or an age >68 years, 24.1% (13/54) of patients would have avoided biopsy but only 1 (10%) csPCa would have been missed, with a sensitivity of 80.0% and negative predictive value (NPV) of 92.3%. For TZ lesions, only 6.0% of the lesions (4/67) were csPCa. The PSA and PSAD values in the PI-RADS 3 TZ lesions were higher in the csPCa group (45.07 and 0.47 ng/mL2, respectively) than in the non-csPCa group (10.03 and 0.17 ng/mL2, respectively).ConclusionsCsPCa was detected at a relatively high rate in PI-RADS 3 PZ lesions. Combining PSAD and age could help to reduce excessive biopsies of such lesions. CsPCa is unlikely to be detected in PI-RADS 3 TZ lesions; thus, active surveillance may be an optimal choice for these lesions, especially among patients without high-risk factors.

Dataset Information

PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?

Objective

Materials and methods

Results

Conclusion

Publications

PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?

Similar Datasets

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