Combination of prostate imaging reporting and data system (PI‐RADS) score and prostate‐specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naïve patients

Abstract

ObjectiveTo assess the value of the Prostate Imaging Reporting and Data System (PI-RADS) scoring system, for prostate multiparametric magnetic resonance imaging (mpMRI) to detect prostate cancer, and classical parameters, such as prostatespecific antigen (PSA) level, prostate volume and PSA density, for predicting biopsy outcome in biopsy na€ ıve patients who have suspected prostate cancer. Patients and methodsPatients who underwent mpMRI at our hospital, and who had their first prostate biopsy between July 2010 and April 2014, were analysed retrospectively. The prostate biopsies were taken transperineally under transrectal ultrasonography guidance. In all, 14 cores were biopsied as a systematic biopsy in all patients. Two cognitive fusion-targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI-RADS scoring system version 2.0 (PI-RADS v2) was used to describe the MRI findings. Univariate and multivariate analyses were performed to determine significant predictors of prostate cancer and clinically significant prostate cancer. ResultsIn all, 288 patients were analysed. The median patient age, PSA level, prostate volume and PSA density were 69 years, 7.5 ng/mL, 28.7 mL, and 0.26 ng/mL/mL, respectively. The biopsy results were benign, clinically insignificant, and clinically significant prostate cancer in 129 (45%), 18 (6%) and 141 (49%) patients, respectively. The multivariate analysis revealed that PI-RADS v2 score and PSA density were independent predictors for prostate cancer and clinically significant prostate cancer. When PI-RADS v2 score and PSA density were combined, a PI-RADS v2 score of ≥4 and PSA density ≥0.15 ng/mL/mL, or PI-RADS v2 score of 3 and PSA density of ≥0.30 ng/mL/mL, was associated with the highest clinically significant prostate cancer detection rates (76-97%) on the first biopsy. Of the patients in this group with negative biopsy results, 22% were subsequently diagnosed as prostate cancer. In contrast, a PI-RADS v2 score of ≤3 and PSA density of <0.15 ng/mL/mL yielded no clinically significant prostate cancer and no additional detection of prostate cancer on further biopsies. ConclusionsA combination of PI-RADS v2 score and PSA density can help in the decision-making process before prostate biopsy and in the follow-up strategy in biopsy na€ ıve patients. Patients with a PI-RADS v2 score of ≤3 and PSA density of <0.15 ng/mL/mL may avoid unnecessary biopsies.

Diagnostic value and relative weight of sequence-specific magnetic resonance features in characterizing clinically significant prostate cancers

“…dPSA was the only non-MR variable included in this study. The fact that it consistently provided independent information to MR features is in line with a recent study that found that combining the PIRADS v2 score with dPSA improved prostate lesion characterization [43]. If the aim of scoring systems is to assess the likelihood of presence of csPCa, it might therefore be necessary to associate MR features and clinical or biochemical features in the future.…”

Detection rate of clinically significant prostate cancer in magnetic resonance imaging and ultrasonography‐fusion transperineal targeted biopsy for lesions with a prostate imaging reporting and data system version 2 score of 3–5

“…PI‐RADS category 3–5 warrant a repeat biopsy for patients with prior negative biopsies according to the American Urological Association and the Society of Abdominal Radiology . However, increasing evidence shows that lesions with PI‐RADS category 3 should be monitored without immediate biopsy to avoid unnecessary biopsy . In combination with additional clinical parameters, such as previous biopsy history, PV and PI‐RADS score, nomograms have yielded higher CSPC detection rates …”

Use of Prostate Specific Antigen Density Combined with Multiparametric Magnetic Resonance Imaging Improves Triage for Prostate Biopsy

“…In our study population, this would have resulted in a 20% decrease in the number of biopsies performed, and only 4% of significant cancers would have escaped diagnosis. If slightly different criteria suggested by other authors were applied to our cohort (i.e., PIRADS = 3 and PSAD < 0.15) [14,16,17], it would result in a 50% reduction in the number of biopsies but would also miss 21% of significant cancers. We speculate that the discrepancy between this finding and those reported in other papers might be explained by the performance of the mpMRI [3,18,19].…”

“…This is similar to our finding that 21% of biopsies could have been avoided using PIRADS < 3 and PSAD < 0.2 as the criteria for deciding not to perform a biopsy. Washino et al [14] reported that PIRADS ≤3 and PSAD < 0.15 ng/mL 2 identified no clinically significant PC on biopsy. They found that the PIRADS score and PSAD were both independent predictors of PC and of CSPC.…”