Detection of clinically significant prostate cancer following initial omission of biopsy in multiparametric MRI era.

Li, Eric V; Busza, Anna M; Siddiqui, Mohammad R; Aguiar, Jonathan A; Keeter, Mary-Kate; Neill, Clayton; Kumar, Sai K; Mi, Xinlei; Schaeffer, Edward M; Patel, Hiten D; Ross, Ashley E

Li, Eric V; Busza, Anna M; Siddiqui, Mohammad R; Aguiar, Jonathan A; Keeter, Mary-Kate; Neill, Clayton; Kumar, Sai K; Mi, Xinlei; Schaeffer, Edward M; Patel, Hiten D; Ross, Ashley E.

Afiliación

Li EV; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA. Eric.li1@northwestern.edu.
Busza AM; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Siddiqui MR; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Aguiar JA; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Keeter MK; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Neill C; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Kumar SK; Department of Preventive Medicine-Division of Biostatistics, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Mi X; Department of Preventive Medicine-Division of Biostatistics, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Schaeffer EM; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Patel HD; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
Ross AE; Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.

Prostate Cancer Prostatic Dis ; 2024 Jun 10.

Article en En | MEDLINE | ID: mdl-38858446

ABSTRACT

ABSTRACT

BACKGROUND:

Multiparametric prostate MRI (mpMRI) is being increasingly adopted for work-up of prostate cancer. For patients selected to omit biopsy, we identified factors associated with repeat MRI, eventual prostate biopsy, and subsequent detection of clinically significant prostate cancer (csPCa, Grade Group ≥2).

METHODS:

We identified biopsy-naïve men presenting with PSA 2-20 ng/mL (March 2018-June 2021) undergoing initial mpMRI with PIRADS 1-3 lesions who were not selected for biopsy with ≥6 months follow-up. We examined factors associated with repeat mpMRI, progression to biopsy, and subsequent detection of csPCa with univariable and multivariable logistic regression.

RESULTS:

Of 1494 men, 31% (463/1494) did not pursue biopsy. PSA density (PSAD) ≤ 0.1, prostate health index (PHI) < 55, and PIRADS 1-2 were associated with omission of prostate biopsy. csPCa diagnosis-free survival was 97.6% (326/334) with median follow up of 23.1 months (IQR 15.1-34.6 months). Black race, PSA, PHI, PSA density, and PSA and PHI velocity were significant predictors of undergoing repeat mpMRI (15.6%, 52/334) and subsequent biopsy (8.4%, 28/334). 8 men were subsequently diagnosed with csPCa (N = 7 on prostate biopsy; N = 1 incidentally on holmium enucleation of prostate). All patients diagnosed with csPCa had PIRADS 4-5 on repeat mpMRI.

CONCLUSIONS:

The subsequent detection rate of csPCa among patients not initially biopsied after mpMRI was low at 2.4%. Decisions to omit biopsy after initial reassuring PHI, PSAD, and mpMRI appear safe with subsequent reassuring serum biomarkers and for cause mpMRI during follow-up.

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Prostate Cancer Prostatic Dis Asunto de la revista: ENDOCRINOLOGIA / NEOPLASIAS / UROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido

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