Are magnetic resonance imaging and targeted biopsies needed in men with serum prostate-specific antigen over 10 ng/ml and an abnormal digital rectal examination?

Morote, Juan; Picola, Natàlia; Paesano, Nahuel; Celma, A.; Muñoz-Rodríguez, Jesús; Asiaín, I.; Ruiz-Plazas, Xavier; Muñoz-Rivero, Marta V.; Manuel, Gloriya Grifth; Servián, Pol; Abascal, José M.

doi:10.1016/j.urolonc.2023.05.003

Cited by 1 publication

(1 citation statement)

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“…BCN-RC 2 incorporates the same variables as BCN-RC 1 but substitutes the DRE prostate volume category with the true prostate volume assessed from MRI and PI-RADS score [22]. It has also been observed that men suspected of having PCa with serum PSA levels exceeding 10 ng/mL and a suspicious digital rectal examination (DRE) can undergo systematic biopsies without the risk of misdiagnosing csPCa [26]. Recently, some RSPs for csPCa detection stratified men suspected of having PCa from serum PSA and DRE in the first stratification, followed by a second stratification from BCN-RC 1, and a third one from BCN-RC 2, and have been reported with good results [27].…”

Section: Introductionmentioning

confidence: 99%

Investigating Efficient Risk-Stratified Pathways for the Early Detection of Clinically Significant Prostate Cancer

Morote,

Borque-Fernando,

Esteban

et al. 2024

JPM

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Risk-stratified pathways (RSPs) are recommended by the European Association of Uro-logy (EAU) to improve the early detection of clinically significant prostate cancer (csPCa). RSPs can reduce magnetic resonance imaging (MRI) demand, prostate biopsies, and the over-detection of insignificant PCa (iPCa). Our goal is to analyze the efficacy and cost-effectiveness of several RSPs by using sequential stratifications from the serum prostate-specific antigen level and digital rectal examination, the Barcelona risk calculators (BCN-RCs), MRI, and Proclarix™. In a cohort of 567 men with a serum PSA level above 3.0 ng/mL who underwent multiparametric MRI (mpMRI) and targeted and/or systematic biopsies, the risk of csPCa was retrospectively assessed using Proclarix™ and BCN-RCs 1 and 2. Six RSPs were compared with those recommended by the EAU that, stratifying men from MRI, avoided 16.7% of prostate biopsies with a prostate imaging–reporting and data system score of <3, with 2.6% of csPCa cases remaining undetected. The most effective RSP avoided mpMRI exams in men with a serum PSA level of >10 ng/mL and suspicious DRE, following stratifications from BCN-RC 1, mpMRI, and Proclarix™. The demand for mpMRI decreased by 19.9%, prostate biopsies by 19.8%, and over-detection of iPCa by 22.7%, while 2.6% of csPCa remained undetected as in the recommended RSP. Cost-effectiveness remained when the Proclarix™ price was assumed to be below EUR 200.

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Section: Introductionmentioning

confidence: 99%