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Combined Use of Prostate-specific Antigen Density and Magnetic Resonance Imaging for Prostate Biopsy Decision Planning: A Retrospective Multi-institutional Study Using the Prostate Magnetic Resonance Imaging Outcome Database (PROMOD).

Julkaisun tekijätFalagario UG, Jambor I, Lantz A, Ettala O, Stabile A, Taimen P, Aronen HJ, Knaapila J, Perez IM, Gandaglia G, Fossati N, Martini A, Cucchiara V, Picker W, Haug E, Haines K, Ratnani P, Sujit N, Lewis S, Sanguedolce F, Selvaggio O, Cormio L, Macarini L, Tewari A, Nordström T, Boström PJ, Briganti A, Carrieri G

KustantajaEuropean Association of Urology


JournalEuropean Urology Oncology

Tietokannassa oleva lehden nimiEuropean urology oncology

Lehden akronyymiEur Urol Oncol



Lopetussivun numero979




Previous studies suggested that prostate-specific antigen (PSA) density (PSAd) combined with magnetic resonance imaging (MRI) may help avoid unnecessary prostate biopsy (PB) with a limited risk of missing clinically significant prostate cancer (csPCa; Gleason grade group [GGG] >1).
To define optimal diagnostic strategies based on the combined use of PSAd and MRI in patients at risk of prostate cancer (PCa).
Design, setting, and participants
A retrospective analysis of the international multicenter Prostate MRI Outcome Database (PROMOD), including 2512 men having undergone PSAd and prostate MRI before PB between 2013 and 2019, was performed.
Outcome measurements and statistical analysis
Rates of avoided PB, missed GGG 1, and csPCa according to 10 strategies based on PSAd values and MRI reporting scores (Prostate Imaging Reporting and Data System [PI-RADS]/Likert/IMPROD biparametric prostate MRI Likert). Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy. Combined systematic and targeted biopsies were used for reference.
Results and limitations
According to DCA, the best strategy in biopsy-naive patients was #7 (PI-RADS/Likert 4–5 or PI-RADS/Likert 3 if PSAd >0.2), which avoided 41.2% PBs while missed 44% of GGG 1 and 10.9% of csPCa cases. From a clinical standpoint, however, strategies with a lower risk of missing csPCa included #10 (PI-RADS/Likert 4–5 or PI-RADS 3 if PSAd >0.10 or PSAd >0.2), which avoided 27% PBs while missing 24.4% GGG 1 and 4% csPCa cases, or #5 (PI-RADS/Likert 3-5 or PSAd > 0.15), which avoided 14.7% PBs while missing 9.3% GGG 1 and 1.7% csPCa cases. Similar results were found in patients with a previous negative biopsy. This study is limited by its retrospective nature, and no central review of MRI and histopathological findings.
Combined PSAd and MRI findings allows individualization of the decision to perform PB on the basis of the risk of missing PCa that both patients and clinicians are ready to accept to avoid this procedure.

Last updated on 2023-31-03 at 13:09