Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI

Abstract

To analyze the clinical characteristics of patients with negative biparametric magnetic resonance imaging (bpMRI) who didn’t need prostate biopsies (PBs). A total of 1,012 male patients who underwent PBs in the First Affiliated Hospital of Nanjing Medical University from March 2018 to November 2019, of 225 had prebiopsy negative bpMRI (defined as Prostate Imaging Reporting and Data System (PI-RADS 2.1) score less than 3). The detection efficiency of clinically significant prostate cancer (CSPCa) was assessed according to age, digital rectal examination (DRE), prostate volume (PV) on bpMRI, prostate-specific antigen (PSA) and PSA density (PSAD). The definition of CSPCa for Gleason score > 6. Univariate and multivariable logistic regression analysis were used to identify predictive factors of absent CSPCa on PBs. Moreover, absent CSPCa contained clinically insignificant prostate cancer (CIPCa) and benign result. The detection rates of present prostate cancer (PCa) and CSPCa were 27.11% and 16.44%, respectively. Patients who were diagnosed as CSPCa had an older age (P < 0.001), suspicious DRE (P < 0.001), a smaller PV (P < 0.001), higher PSA value (P = 0.008) and higher PSAD (P < 0.001) compared to the CIPCa group and benign result group. PSAD < 0.15 ng/ml/cm3 (P = 0.004) and suspicious DRE (P < 0.001) were independent predictors of absent CSPCa on BPs. The negative forecast value of bpMRI for BP detection of CSPCa increased with decreasing PSAD, mainly in patients with naive PB (P < 0.001) but not in prior negative PB patients. 25.33% of the men had the combination of negative bpMRI, PSAD < 0.15 ng/ml/cm3 and PB naive, and none had CSPCa on repeat PBs. The incidence of PB was determined, CSPCa was 1.59%, 0% and 16.67% in patients with negative bpMRI and PSAD < 0.15 ng/ml/cm3, patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and biopsy naive and patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and prior negative PB, separately. We found that a part of patients with negative bpMRI, a younger age, no suspicious DRE and PSAD < 0.15 ng/ml/cm3 may securely avoid PBs. Conversely PB should be considered in patients regardless of negative bpMRI, especially who with a greater age, obviously suspicious DRE, significantly increased PSA value, a significantly small PV on MRI and PSAD > 0.15 ng/ml/cm3.

Urine Exosomal AMACR Is a Novel Biomarker for Prostate Cancer Detection at Initial Biopsy

“…The diagnostic rate of PCa has steadily increased with the increased PSA screening ( 17 )... In spite of abnormal DRE and transrectal ultrasound (TRUS) triggering prostate biopsy, PSA is still the main indicator for prostate biopsy ( 18 ). Higher levels of PSA are routinely used in predicting PCa risk.…”

Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

“…The small number of inhouse PI-RADS 2 lesions may confine the generalizability of our results but is explainable by a broad agreement to not classify PI-RADS 2 reports as suspicious. As a result, these patients are referred only sporadically for invasive diagnostic procedures, despite upgrading of PI-RADS 2 reports has been shown to be nearly 18% ( 30 ). In addition, 89% of inhouse PI-RADS 2 results represented downgraded extramural PI-RADS ≥3 reports (data not shown), probably relying on a recently attested moderate interobserver agreement for PI-RADS version 2 ( 49 ).…”

“…Last, until now no definitive efforts have been made to distinguish between PI-RADS 2 reports representing target less mpMRI showing csPCa detection rates with SB from 3% to 24% in heterogenous groups ( 2 , 14 , 28 – 30 ) and visible PI-RADS 2 mpMRI lesions, which have been associated with csPCa in 7% in a multicenter cross-sectional study ( 31 ). To verify these PI-RADS 2 lesion results, we also assessed PCa detection rates of in-house PI-RADS 2 lesions after radiologic reevaluation.…”

A Novel Urine Exosomal lncRNA Assay to Improve the Detection of Prostate Cancer at Initial Biopsy: A Retrospective Multicenter Diagnostic Feasibility Study

“…With the increase in PSA screening, the diagnostic rate of prostate cancer has steadily increased [16]. While abnormal DRE and transrectal ultrasound (TRUS) results prompt a biopsy of the prostate in patients [17], the PSA is still the most reliable prostate biopsy indicator. As a routinely used test, higher levels of the PSA indicate a greater likelihood of PCa.…”