Prediction of Significant Prostate Cancer in Equivocal Magnetic Resonance Imaging Lesions: A High-volume International Multicenter Study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • GeSRU Academics Prostate Cancer Group - (Author)
  • August Sigle - , Berta-Ottenstein-Programme (Author)
  • Angelika Borkowetz - , Department of Urology (Author)
  • Jost von Hardenberg - , Heidelberg University of Education (Author)
  • Martin Drerup - , Hospital Barmherzige Brüder Salzburg (Author)
  • Kira Kornienko - , Charité – Universitätsmedizin Berlin (Author)
  • Jeremy Kwe - , Department of Urology (Author)
  • Mike Wenzel - , Goethe University Frankfurt a.M. (Author)
  • Philipp Mandel - , Goethe University Frankfurt a.M. (Author)
  • Niklas Westhoff - , Heidelberg University of Education (Author)
  • Constantin Rieger - , Uniklinik Köln (Author)
  • Manuela A Hoffmann - , Rush University (Author)
  • Gernot Ortner - , Landeskrankenhaus Hall Tirol (Author)
  • Samy Mahjoub - , Hannover Medical School (MHH) (Author)

Abstract

BACKGROUND: Decision of performing prostate biopsy in men with Prostate Imaging Reporting and Data System (PI-RADS) 3 findings in prostate magnetic resonance imaging (MRI) is challenging as they have a low but still relevant risk of harboring significant prostate cancer (sPC).

OBJECTIVE: To identify clinical predictors of sPC in men with PI-RADS 3 lesions in prostate MRI and to analyze the hypothetical effect of incorporating prostate-specific antigen density (PSAD) into biopsy decision.

DESIGN, SETTING, AND PARTICIPANTS: We analyzed a retrospective multinational cohort from ten academic centers comprising 1476 men who underwent a combined prostate biopsy (MRI targeted plus systematic biopsy) between February 2012 and April 2021 due to a PI-RADS 3 lesion in prostate MRI.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was the detection of sPC (ISUP ≥2) in a combined biopsy. Predictors were identified by a regression analysis. Descriptive statistics were applied to evaluate the hypothetical effect of involving PSAD into biopsy decision.

RESULTS AND LIMITATIONS: Of all patients, 273/1476 (18.5%) were diagnosed with sPC. MRI-targeted biopsy diagnosed fewer sPC cases than combined strategy: 183/1476 (12.4%) versus 273/1476 (18.5%), p < 0.01. Age (odds ratio [OR] 1.10 [95% confidence interval {CI}: 1.05-1.15], p < 0.001), prior negative biopsy (OR 0.46 [0.24-0.89], p = 0.022), and PSAD (p < 0.001) were found to be independent predictors of sPC. Applying a PSAD cutoff of 0.15, 817/1398 (58.4%) biopsies would have been avoided at the cost of missing sPC in 91 (6.5%) men. Limitations were the retrospective design, heterogeneity of the study cohort due to the long inclusion period, and no central revision of MRI.

CONCLUSIONS: Age, previous biopsy status, and PSAD were found to be independent predictors of sPC in men with equivocal prostate MRI. Implementation of PSAD into biopsy decision can avoid unnecessary biopsies. Clinical parameters such as PSAD need validation in a prospective setting.

PATIENT SUMMARY: In this study, we looked for clinical predictors of significant prostate cancer in men with Prostate Imaging Reporting and Data System 3 lesions in prostate magnetic resonance imaging. We identified age, previous biopsy status, and especially prostate-specific antigen density as independent predictors.

Details

Original languageEnglish
Pages (from-to)606-613
Number of pages8
JournalEuropean urology focus
Volume9
Issue number4
Early online date30 Jan 2023
Publication statusPublished - Jul 2023
Peer-reviewedYes

External IDs

Scopus 85148369746

Keywords

Sustainable Development Goals

Keywords

  • Humans, Image-Guided Biopsy/methods, Magnetic Resonance Imaging/methods, Male, Prospective Studies, Prostate-Specific Antigen, Prostatic Neoplasms/diagnostic imaging, Retrospective Studies

Library keywords