(UroToday.com) The 2024 Southeastern Section of the AUA (SESAUA) annual meeting featured a prostate cancer session and a presentation by Dr. Christine Lightfoot discussing screening with PSA and MRI. MRI incorporation into prostate cancer screening protocols has been associated with decreased rates of low-risk prostate cancer diagnosis.1,2 Whether this has changed characteristics of patients with newly diagnosed very low-risk or low-risk disease has not been fully described. The aim of this study presented at SESAUA 2024 was to evaluate the trend of newly diagnosed prostate cancer based on AUA and NCCN risk categories after screening with PSA and MRI at an equal access institution.
A prospective chart review study was conducted on all patients undergoing a prostate biopsy at a VA hospital from October 2017 to June 2023. Patients were included under the following criteria:
- Patients who underwent an MRI and PSA drawn prior to biopsy
- Uronav biopsy of ROI lesion
Patients were excluded if the biopsy indication was solely based on PSA or TURP. Non-parametric data was evaluated using a Mann-Whitney U and categorical data using Fisher exact tests. Clinically significant prostate cancer was defined as any Gleason grade ≥ 3+4.
Among 655 patients, the median age was 68 years, median BMI was 28.3 kg/m2, and median PSA prior to biopsy was 5.9 ng/mL, with 62.4% (n = 409) of men self-identified as African American. Upon AUA risk stratifying, 257 (39.2%) had benign pathology and 104 (15.9%) low-risk. When stratifying the AUA low-risk by NCCN guidelines, 63 (9.6%) had very low-risk and 41 (6.3%) low-risk prostate cancer. Patients were then separated by year and PI-RADS, showing a stable trend in newly diagnosed very low-risk disease from 2018 through 2022 across all PI-RADS:
Moreover, African American and non-African American men showed comparable rates of clinically significant prostate cancer across all PI-RADS and years.
Dr. Lightfoot concluded her presentation discussing screening with PSA and MRI with the following conclusions:
- While MRI has been the most impactful study to reduce overdiagnosis, patients with very low-risk disease are routinely identified
- Further evaluation is needed to elucidate patients harboring clinically localized and indolent disease away from biopsy intense protocols
- This study also found African American patients, who classically harbor higher risk disease, were diagnosed with clinically significant prostate cancer at comparable rates to their non-African American counterparts
- This data suggests race may no longer be a clinically significant prostate cancer risk factor in an equal access setting
Presented by: Christine Lightfoot, MD Candidate, Tulane University, New Orleans, LA
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting, Austin, TX, Wed, Mar 20 – Sat, Mar 23, 2024.
References:
- Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): A paired validating confirmatory study. Lancet 2017;389(10071):815-822.
- Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate cancer diagnosis. N Engl J Med 2018;378(19):1767-1777.