Detection of clinically significant prostate cancer with PI-RADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions

Westphalen, Antonio C.; Fazel, Farhad; Nguyen, Hao G.; Cabarrus, Miguel; Hanley-Knutson, Katryana; Shinohara, Katsuto; Carroll, Peter R.

doi:10.1590/s1677-5538.ibju.2018.0768

Cited by 16 publications

(12 citation statements)

References 17 publications

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“…Since PIRADS 3 lesions are considered equivocal with 8%‐47% rates of GG2‐5 PCa, this is an area where an additional screening test used in series with adequate specificity would allow more men to avoid unnecessary biopsies. 11 , 12 PIRADS 3 lesions were present in 32.9% of participants and was the most frequently detected score on mpMRI. Our study demonstrated that when PHI is used as a serial test to PIRADS 3 lesions, a PHI threshold of ≥49 avoided unnecessary biopsies in 55% of men without missing any GG2‐5 PCa.…”

Section: Discussionmentioning

confidence: 95%

“…Although across all PIRADS categories PSA density yielded higher AUCs, in men with PIRADS 3, PHI proved to be more useful than PSA density in eliminating unnecessary biopsies. Since PIRADS 3 lesions are considered equivocal with 8%‐47% rates of GG2‐5 PCa, this is an area where an additional screening test used in series with adequate specificity would allow more men to avoid unnecessary biopsies 11,12 . PIRADS 3 lesions were present in 32.9% of participants and was the most frequently detected score on mpMRI.…”

Section: Discussionmentioning

confidence: 99%

“… 10 This is especially true in men with equivocal scores on the Prostate Imaging Reporting and Data System (PIRADS). While scores on the higher (PIRADS 4‐5) and lower (PIRADS 1‐2) ends of this scale have been shown to have high positive predictive value (PPV) and NPV, respectively, the prevalence of GG2‐5 in PIRADS 3 lesions ranges between 8% and 47%, 11 , 12 making biopsy decisions for patients in this group difficult. Moreover, it is unclear if mpMRI performs differently in non‐White populations since most of the validations do not include large numbers of minorities.…”

Section: Introductionmentioning

confidence: 99%

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Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer

et al. 2021

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Objective To compare Prostate Health Index (PHI) and prostate‐specific antigen (PSA) density as secondary tests after multiparametric magnetic resonance imaging (mpMRI) in improving the detection accuracy of Gleason grade group (GG) 2‐5 prostate cancer (PCa) and in decreasing unnecessary biopsies in a multiethnic biopsy‐naïve population. Methods From February 2017 to February 2020, we recruited consecutive biopsy‐naïve men in participating urology clinics for elevated PSA levels. They all had a PHI score, mpMRI, and prostate biopsy. Experienced genitourinary radiologists read all mpMRI studies based on PIRADS version 2.0. Logistic regression models were used to generate receiver operating characteristic curves. Models were tested for effect modification between Race (Black vs White) and both PHI and PSA density, and Race and PIRADS to determine if race impacted their prediction accuracy. Sensitivity, specificity, and predictive values of PHI and PSA density thresholds were calculated by PIRADS scores. The primary outcome was GG2‐5 PCa, that is, Gleason score ≥3 + 4. Results The study included 143 men, of which 65 (45.5%) were self‐reported Black. Median age was 62.0 years and 55 men (38.4%) had GG2‐5 PCa. Overall, 18.1% had PIRADS 1‐2, 32.9% had PIRADS 3, and 49.0% had PIRADS 4‐5. For the binary logistic regressions, the interactions between PIRADS and Race (P = .08), Log (PHI) and Race (P = .17), and Log (PSA density) and Race (P = .42) were not statistically significant. Within PIRADS 3 lesions, a PHI ≥49 prevented unnecessary biopsies in 55% of men and missed no GG2‐5 PCa, yielding a negative predictive value of 100%. There was no reliable PHI or PSA density threshold to avoid PCa biopsies in PIRADS 1‐2 or 4‐5. Conclusions PHI and PSA density can be used after mpMRI to improve the detection of GG2‐5 PCa in a biopsy‐naïve cohort. PHI may be superior to PSA density in PIRADS 3 lesions by avoiding 55% of unnecessary biopsies. Using both PHI and PSA density in series may further increase specificity and lead to fewer unnecessary biopsies, but further larger studies are warranted to determine the optimal threshold of each biomarker.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer

et al. 2021

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“…In 2020, Pagniez et al showed that PSA density predicts the detection of cs-PCa by systematic biopsy in MRI-negative patients [ 16 ]. Further, PSA density was also shown to be an independent predictor of cs-PCa in men with visible lesions on MRI [ 21 , 22 ]. While our results found that PSA density predicts the detection of cs-PCa by systematic biopsy, PSA density did not predict cancer upgrade on systematic biopsy.…”

Section: Discussionmentioning

confidence: 99%

US lesion visibility predicts clinically significant upgrade of prostate cancer by systematic biopsy

et al. 2022

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Purpose To identify predictors of when systematic biopsy leads to a higher overall prostate cancer grade compared to targeted biopsy. Methods and materials 918 consecutive patients who underwent prostate MRI followed by MRI/US fusion biopsy and systematic biopsies from January 2015 to November 2019 at a single academic medical center were retrospectively identified. The outcome was upgrade of PCa by systematic biopsy, defined as cases when systematic biopsy led to a Gleason Grade (GG) ≥ 2 and greater than the maximum GG detected by targeted biopsy. Generalized linear regression and conditional logistic regression were used to analyze predictors of upgrade. Results At the gland level, the presence of an US-visible lesion was associated with decreased upgrade (OR 0.64, 95% CI 0.44–0.93, p = 0.02). At the sextant level, upgrade was more likely to occur through the biopsy of sextants with MRI-visible lesions (OR 2.58, 95% CI 1.87–3.63, p < 0.001), US-visible lesions (OR 1.83, 95% CI 1.14–2.93, p = 0.01), and ipsilateral lesions (OR 3.89, 95% CI 2.36–6.42, p < 0.001). Conclusion Systematic biopsy is less valuable in patients with an US-visible lesion, and more likely to detect upgrades in sextants with imaging abnormalities. An approach that takes additional samples from regions with imaging abnormalities may provide analogous information to systematic biopsy.

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“…There are different recommended thresholds for elevated PSAD in the literature, with levels ranging between 0.12 and 0.15 widely quoted 10,11 . In order to inform decision‐making with locally available data we have analysed a cohort of 426 patients undergoing trans‐perineal template‐guided prostate biopsy after mp‐MRI within our unit.…”

Section: Introductionmentioning

confidence: 99%

Benefits of pre‐biopsy multi‐parametric magnetic resonance imaging scanning in the initial assessment of prostate cancer

McAllister

Jarvis

Smith

et al. 2020

Int J of Uro Nursing

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Traditionally, men referred for investigation of raised prostate specific antigen (PSA) could expect to be investigated via blind TRUS biopsy. In recent years, the availability of pre‐biopsy imaging with multi‐parametric magnetic resonance imaging (mp‐MRI) has allowed urology centres to improve their triage and care of this patient cohort. The ability to identify discrete lesions for more accurately targeted TRUS, stream patients with anterior lesions for trans‐perineal biopsy, and of course to prevent those with no evidence of clinically significant prostate cancer from being subjected to unnecessary procedures has proved pre‐biopsy mp‐MRI a valuable tool in the assessment and diagnosis of prostate cancer. Our service recently audited the impact of the introduction of mp‐MRI on our prostate cancer assessment pathway. An analysis of the outcomes of 1558 referrals over a 2‐year period, and found that pre‐biopsy imaging has resulted in a marked reduction in unnecessary procedures and more accurate targeting of lesions, leading to improved outcomes for patients.

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Detection of clinically significant prostate cancer with PI-RADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions

Cited by 16 publications

References 17 publications

Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer

Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer

US lesion visibility predicts clinically significant upgrade of prostate cancer by systematic biopsy

Benefits of pre‐biopsy multi‐parametric magnetic resonance imaging scanning in the initial assessment of prostate cancer

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