BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) has excellent sensitivity in detecting significant prostate cancer (sPC). Nevertheless, uncertainty exists regarding the management of Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions. OBJECTIVE: To investigate whether PI-RADS 3 lesions in combination with clinical parameters, especially prostate-specific antigen density (PSAD), can be used to exclude sPC. DESIGN, SETTING, AND PARTICIPANTS: A total of 455 consecutive biopsy-naïve men underwent MRI-guided transperineal prostate fusion biopsy at our department between 2017 and 2018. We identified 101 patients who had exclusively one or more PI-RADS 3 lesions on mpMRI. sPC was defined as intermediate- and high-risk PC (according to the D'Amico risk classification). OUTCOME MEASURES AND STATISTICAL ANALYSIS: Univariate logistic regression analysis was performed to test different clinical factors as predictors of sPC in men with PI-RADS 3 lesions. The probability of sPC prediction was calculated for different PSAD thresholds. RESULTS AND LIMITATIONS: Among patients with PI-RADS 3 lesions, PSAD was a significant predictor of sPC (p = 0.005). For a PI-RADS score of 3 the probability of excluding sPC was 85% (86/101), which increased to 98% (42/43) when combined with PSAD <0.1 ng/ml/ml. CONCLUSIONS: Inclusion of PSAD < 0.1 ng/ml/ml in the strategy for biopsy-naïve patients with equivocal mpMRI findings would allow a reduction in prostate biopsies in 43% (43/101) of cases at the cost of missing a very small number (2%, 1/43) of intermediate-risk PCs. PATIENT SUMMARY: At high-volume tertiary care centers with significant experience in prostate multiparametric magnetic resonance imaging, immediate biopsies could be safely omitted for men with lesions with a Prostate Imaging-Reporting and Data System score of 3 and prostate-specific antigen density of PSAD < 0.1 ng/ml/ml. Any decision to omit an immediate biopsy should be associated with close monitoring.
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) has excellent sensitivity in detecting significant prostate cancer (sPC). Nevertheless, uncertainty exists regarding the management of Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions. OBJECTIVE: To investigate whether PI-RADS 3 lesions in combination with clinical parameters, especially prostate-specific antigen density (PSAD), can be used to exclude sPC. DESIGN, SETTING, AND PARTICIPANTS: A total of 455 consecutive biopsy-naïve men underwent MRI-guided transperineal prostate fusion biopsy at our department between 2017 and 2018. We identified 101 patients who had exclusively one or more PI-RADS 3 lesions on mpMRI. sPC was defined as intermediate- and high-risk PC (according to the D'Amico risk classification). OUTCOME MEASURES AND STATISTICAL ANALYSIS: Univariate logistic regression analysis was performed to test different clinical factors as predictors of sPC in men with PI-RADS 3 lesions. The probability of sPC prediction was calculated for different PSAD thresholds. RESULTS AND LIMITATIONS: Among patients with PI-RADS 3 lesions, PSAD was a significant predictor of sPC (p = 0.005). For a PI-RADS score of 3 the probability of excluding sPC was 85% (86/101), which increased to 98% (42/43) when combined with PSAD <0.1 ng/ml/ml. CONCLUSIONS: Inclusion of PSAD < 0.1 ng/ml/ml in the strategy for biopsy-naïve patients with equivocal mpMRI findings would allow a reduction in prostate biopsies in 43% (43/101) of cases at the cost of missing a very small number (2%, 1/43) of intermediate-risk PCs. PATIENT SUMMARY: At high-volume tertiary care centers with significant experience in prostate multiparametric magnetic resonance imaging, immediate biopsies could be safely omitted for men with lesions with a Prostate Imaging-Reporting and Data System score of 3 and prostate-specific antigen density of PSAD < 0.1 ng/ml/ml. Any decision to omit an immediate biopsy should be associated with close monitoring.
Authors: Heinz-Peter Schlemmer; Bernd Joachim Krause; Viktoria Schütz; David Bonekamp; Sarah Marie Schwarzenböck; Markus Hohenfellner Journal: Dtsch Arztebl Int Date: 2021-10-22 Impact factor: 8.251
Authors: Daniël F Osses; Christian Arsov; Lars Schimmöller; Ivo G Schoots; Geert J L H van Leenders; Irene Esposito; Sebastiaan Remmers; Peter Albers; Monique J Roobol Journal: J Pers Med Date: 2020-12-10
Authors: Valentina Brancato; Marco Aiello; Luca Basso; Serena Monti; Luigi Palumbo; Giuseppe Di Costanzo; Marco Salvatore; Alfonso Ragozzino; Carlo Cavaliere Journal: Sci Rep Date: 2021-01-12 Impact factor: 4.379
Authors: Magdalena Görtz; Joanne Nyaboe Nyarangi-Dix; Lars Pursche; Viktoria Schütz; Philipp Reimold; Constantin Schwab; Albrecht Stenzinger; Holger Sültmann; Stefan Duensing; Heinz-Peter Schlemmer; David Bonekamp; Markus Hohenfellner; Jan Philipp Radtke Journal: Cancers (Basel) Date: 2022-02-10 Impact factor: 6.639
Authors: Juan Morote; Miriam Campistol; Marina Triquell; Anna Celma; Lucas Regis; Inés de Torres; Maria E Semidey; Richard Mast; Anna Santamaria; Jacques Planas; Enrique Trilla Journal: Eur Urol Open Sci Date: 2022-01-23