Predictors of Clinically Significant Prostate Cancer in Patients with PIRADS Categories 3–5 Undergoing Magnetic Resonance Imaging-Ultrasound Fusion Biopsy of the Prostate

Abstract

Prostate biopsy is recommended in cases of positive magnetic resonance imaging (MRI), defined as Prostate Imaging Reporting and Data System (PIRADS) category ≥ 3. However, most men with positive MRIs will not be diagnosed with clinically significant prostate cancer (csPC). Our goal was to evaluate pre-biopsy characteristics that influence the probability of a csPC diagnosis in these patients. We retrospectively analyzed 740 consecutive men with a positive MRI and no prior PC diagnosis who underwent MRI-ultrasound fusion biopsies of the prostate in three centers. csPC detection rates (CDRs) for each PIRADS category were calculated. Patient, disease, and lesion characteristics were studied for interdependencies with the csPC diagnosis. The CDR in patients with PIRADS categories 3, 4, and 5 was 10.5%, 30.7%, and 54.6%, respectively. On both uni- and multivariable regression models, older age, being biopsy-naïve, prostate specific antigen ≥ 10 ng/mL, smaller prostate volume, PIRADS > 3, a larger maximum lesion size, a lesion in the peripheral zone, and a positive digital rectal examination were associated with csPC. In this large, multicenter study, we provide new data regarding CDRs in particular PIRADS categories. In addition, we present several strong predictors that further alter the risk of csPC in MRI-positive patients. Our results could help in refining individual risk assessment, especially in PIRADS 3 patients, in whom the risk of csPC is substantially low.

Effectiveness of Magnetic Resonance Imaging/Ultrasound-guided Target Biopsy in Detecting Clinically Significant Prostate Cancer

“…suggested the following independent predictive factors for CSPC in patients with PI-RADS 4 and 5 lesions: i) PI-RADS category 5, ii) prostate volume <40 ml, iii) no history of prostate biopsy, iv) lesion located in the PZ or both TZ and PZ, and v) PSAD >0.35 ng/ml/ml (12). Moreover, Szempliński et al (10) demonstrated that older age and a large maximum ROI size were associated with an increased risk of CSPC diagnosis. In summary, older age, no history of biopsy, high PI-RADS scores, high PSAD, low prostate volumes, PCa located in the PZ, and a large ROI are among the key factors leading to the detection of CSPC.…”

“…In other words, some patients with PI-RADS 4 or 5 lesions are targeted biopsy (TB)-negative (8). Moreover, only a few studies (9)(10)(11) have elucidated the factors leading to TB negativity among these patients.…”

Effectiveness of Magnetic Resonance Imaging/Ultrasound-Guided Target Biopsy in Detecting Clinically Significant Prostate Cancer

“…In a previous report, Hakozaki et al suggested the following independent predictive factors for CSPC in patients with PI-RADS 4 and 5 lesions: i) PI-RADS category 5, ii) prostate volume < 40 mL, iii) no history of prostate biopsy, iv) lesion located in the PZ or both the TZ and PZ, and v) PSAD > 0.35 ng/mL/mL[11]. Moreover, Szempliński, et al demonstrated that older age, no previous biopsy history, having a PSA level ≥ 10 ng/mL, a small prostate volume, a PI-RADS category > 3, a large maximum ROI size, and a lesion located in the PZ were associated with an increased risk of CSPC diagnosis[12]. In summary, no history of biopsy, high PI-RADS scores, high PSAD, low prostate volumes, PCa located in the PZ, and a large ROI are among the key factors leading to the detection of CSPC.Furthermore, to increase the CSPC detection rate, we evaluated TB-negative patients with PI-RADS 4 or 5 lesions and found that 20% and 21% of those with PI-RADS 4 and 5 lesions, respectively, were TB-negative.Apfelbeck et al showed that TB was negative in 25.6% (126/493) of patients with PI-RADS 4 lesions and 12.7% (45/355) of those with PI-RADS 5 lesions[13].…”