The recommendation to perform biopsy of PIRADS 3 lesions has not been adopted with strength as compared to higher scored lesions on multiparametric MRI. This represents a challenging scenario and an unmet need for clinicians to apply a risk adapted approach in these cases.
In the present study, we examined clinical and radiologic characteristics in men with PI-RADS 3 index lesions that can predict csPCa on mpMRI-target biopsy.
Revision of a prospective database with patients who underwent targeted and systematic biopsies from 2015 to 2023 for PI-RADS 3 lesions identified on mpMRI. Baseline variables were collected, such as PSA density (PSAd), 4Kscore, prostate size, and the apparent diffusion coefficient (ADC) value of the lesion on mpMRI. Logistic regression, receiver operating characteristic (ROC) and decision curve analyses (DCA) assessing the association between clinic-radiologic factors and csPCa were performed.
Overall, 230 patients were included in the study and the median age was 65 years. The median prostate size and PSA were 50 g and 6.26 ng/mL, respectively. 17.4% of patients had csPCa, while 27.5% had Gleason group 1. In univariable logistic analyses, we found that age, BMI, prostate size, PSAd, ADC, and 4Kscore were significant csPCa predictors (P < 0.05). PSAd showed the best prediction performance in terms of AUC (= 0.679). On multivariable analysis, PSAd and 4Kscore were associated with csPCa. The net benefit of PSAd combined with clinical features was superior to those of other parameters. Within patients with PSAd < 0.15, 4Kscore was a statistically significant predictor of csPCa (OR = 3.25, P = 0.032).
PSAd and 4Kscore are better predictors of csPCa in patients with PIRADS 3 lesions compared to ADC. The predictive role of 4Kscore is higher in patients with low PSAd. These results can assist practitioners in the risk stratification of patients with equivocal lesions to determine the need of biopsy.
Urologic oncology. 2024 Jul 05 [Epub ahead of print]
Tarek Ajami, Sunwoo Han, Joao G Porto, Isabella Kimbel, Zoe Szczotka, Timothy Guerard, Nathan VanderVeer-Harris, Braian R Ledesma, Patricia Castillo Acosta, Oleksandr N Kryvenko, Dipen J Parekh, Radka Stoyanova, Isildinha M Reis, Sanoj Punnen
Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL. Electronic address: ., Department of Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL., Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL., Department of Radiation Oncology, University of Miami, Miller School of Medicine, Miami, FL., Florida International University, Herbert Wertheim College of Medicine, Miami, FL., Department of Radiology, University of Miami, Miller School of Medicine, Miami, FL., Department of Pathology and Laboratory Medicine, University of Miami, Miller School of Medicine, Miami, FL., Department of Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL; Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38971674