PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer

Frisbie, James; Besien, Alexa J. Van; Lee, Adrianna; Xu, Linhan; Wang, Shu; Choksi, Ankur; Afzal, Madiha; Naslund, Michael J.; Lane, Barton; Wong, Joseph; Wnorowski, Amelia M.; Siddiqui, Mohummad Minhaj

doi:10.1038/s41391-022-00549-y

Cited by 20 publications

(22 citation statements)

References 20 publications

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“…In this issue of Prostate Cancer and Prostatic disease Friesbie et al show that PSA density (PSAd) is complementary to PI-RADS in detecting csPCa [5]. The study retrospectively included 327 men with 709 lesions who underwent both targeted and systematic biopsy.…”

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The role of PSA density in the MRI pathway for prostate cancer diagnostics

Cash

Schostak

2022

Prostate Cancer Prostatic Dis

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confidence: 99%

The role of PSA density in the MRI pathway for prostate cancer diagnostics

Cash

Schostak

2022

Prostate Cancer Prostatic Dis

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“…Frisbie et al have evaluated the role of PSA density together with MRI to stratify PCa risk. The authors enrolled a consecutive series of 327 patients undergoing fusion biopsies and estimated an accuracy of 0.67 for PSA density (PSAd) and of 0.72 for PIRADS score to predict clinically significant cancer (Gleason ≥7) [2]. Using a cut-off of 0.10 ng/ml for PSA density together with PIRADS score an AUC of 0.82 for the prediction of clinically significant (CS) PCa was observed.…”

Section: Psa Density Is Complementary To the Prostate Mri Pi-rads Sco...mentioning

confidence: 99%

Best of 2022 in prostate cancer and prostatic diseases

Nunzio

Lombardo

2023

Prostate Cancer Prostatic Dis

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“…As such, ancillary clinical data have been proposed to complement MRI to minimize the number of unnecessary biopsies. This concept has been recently expanded by numerous studies, and several MRI-based risk models and strategies have been developed to guide decisions on prostate biopsy . However, it has been challenging to integrate the proposed approaches into clinical practice owing to considerable inconsistencies among them.…”

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“…BMI (9 studies,13,17,19,24,25,31,39,49,79 3946 patients) 24.7 (24.2-30.8)Positive family history of PCa (16 studies,12,24,26,38,44,46,49,52,56,58,[62][63][64][72][73][74] 10 095 patients), %17 (1-35)Positive DRE (33 studies,10, 15, 17, 18, 21-23, 26, 31-33, 37, 38, 41, 42, 44-47, 51-53, 56, 58, 62-64, 72-74, 77, 78, 81 19 129 patients), %23 (7-68)Black race (5 studies,12,15,46,66,79 1880 patients), % 14 (1-29) Prior negative biopsy (58 studies, 10-13, 15, 17, 18, 21-26, 28, 29, 31, 33-35, 37-58, 60-67, 70-74, 76-79 31 177 patients), % 18 (0-100) Abbreviations: BMI, body mass index (measured as weight in kilograms divided by height in meters squared); csPCa, clinically significant prostate cancer; DRE, digital rectal examination; MRI, magnetic resonance imaging; PI-RADS, Prostate Imaging Reporting & Data System; PSA, prostate-specific antigen; PSAD, prostate-specific antigen density. SI conversion factor: To convert PSA levels to μg/L, multiply by 1.0. a Specified per row.…”

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Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Haj-Mirzaian,

Burk,

Lacson

et al. 2024

JAMA Netw Open

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ImportanceMultiple strategies integrating magnetic resonance imaging (MRI) and clinical data have been proposed to determine the need for a prostate biopsy in men with suspected clinically significant prostate cancer (csPCa) (Gleason score ≥3 + 4). However, inconsistencies across different strategies create challenges for drawing a definitive conclusion.ObjectiveTo determine the optimal prostate biopsy decision-making strategy for avoiding unnecessary biopsies and minimizing the risk of missing csPCa by combining MRI Prostate Imaging Reporting &amp; Data System (PI-RADS) and clinical data.Data SourcesPubMed, Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to July 1, 2022.Study SelectionEnglish-language studies that evaluated men with suspected but not confirmed csPCa who underwent MRI PI-RADS followed by prostate biopsy were included. Each study had proposed a biopsy plan by combining PI-RADS and clinical data.Data Extraction and SynthesisStudies were independently assessed for eligibility for inclusion. Quality of studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and the Newcastle-Ottawa Scale. Mixed-effects meta-analyses and meta-regression models with multimodel inference were performed. Reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.Main Outcomes and MeasuresIndependent risk factors of csPCa were determined by performing meta-regression between the rate of csPCa and PI-RADS and clinical parameters. Yields of different biopsy strategies were assessed by performing diagnostic meta-analysis.ResultsThe analyses included 72 studies comprising 36 366 patients. Univariable meta-regression showed that PI-RADS 4 (β-coefficient [SE], 7.82 [3.85]; P = .045) and PI-RADS 5 (β-coefficient [SE], 23.18 [4.46]; P &lt; .001) lesions, but not PI-RADS 3 lesions (β-coefficient [SE], −4.08 [3.06]; P = .19), were significantly associated with a higher risk of csPCa. When considered jointly in a multivariable model, prostate-specific antigen density (PSAD) was the only clinical variable significantly associated with csPCa (β-coefficient [SE], 15.50 [5.14]; P &lt; .001) besides PI-RADS 5 (β-coefficient [SE], 9.19 [3.33]; P &lt; .001). Avoiding biopsy in patients with lesions with PI-RADS category of 3 or less and PSAD less than 0.10 (vs &lt;0.15) ng/mL2 resulted in reducing 30% (vs 48%) of unnecessary biopsies (compared with performing biopsy in all suspected patients), with an estimated sensitivity of 97% (vs 95%) and number needed to harm of 17 (vs 15).Conclusions and RelevanceThese findings suggest that in patients with suspected csPCa, patient-tailored prostate biopsy decisions based on PI-RADS and PSAD could prevent unnecessary procedures while maintaining high sensitivity.

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PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer

Cited by 20 publications

References 20 publications

The role of PSA density in the MRI pathway for prostate cancer diagnostics

The role of PSA density in the MRI pathway for prostate cancer diagnostics

Best of 2022 in prostate cancer and prostatic diseases

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

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