Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy

Wei, John T.; Barocas, Daniel A.; Carlsson, Sigrid; Coakley, Fergus V.; Eggener, Scott E.; Etzioni, Ruth; Fine, Samson W.; Han, Misop; Kim, Sennett K; Kirkby, Erin; Konety, Badrinath R.; Miner, Martin; Moses, Kelvin A.; Nissenberg, Merel G; Pinto, Peter A; Salami, Simpa S.; Souter, Lesley; Thompson, Ian M.; Lin, Daniel W.

doi:10.1097/ju.0000000000003492

Cited by 52 publications

(25 citation statements)

References 49 publications

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“…There remains substantial controversy regarding prostate-specific antigen (PSA) screening for PCa, particularly its potential to result in overdiagnosis of low-risk disease . Despite these concerns, PSA screening remains a commonly used tool, and both American Urological Association and American Cancer Society guidelines continue to include PSA screening for PCa diagnosis …”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results

Yun,

Kim,

Gandhe

et al. 2023

JAMA Netw Open

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ImportanceMagnetic resonance imaging (MRI) and potential MRI-guided biopsy enable enhanced identification of clinically significant prostate cancer. Despite proven efficacy, MRI and potential MRI-guided biopsy remain costly, and there is limited evidence regarding the cost-effectiveness of this approach in general and for different prostate-specific antigen (PSA) strata.ObjectiveTo examine the cost-effectiveness of integrating annual MRI and potential MRI-guided biopsy as part of clinical decision-making for men after being screened for prostate cancer compared with standard biopsy.Design, Setting, and ParticipantsUsing a decision analytic Markov cohort model, an economic evaluation was conducted projecting outcomes over 10 years for a hypothetical cohort of 65-year-old men in the US with 4 different PSA strata (&lt;2.5 ng/mL, 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, &gt;10 ng/mL) identified by screening through Monte Carlo microsimulation with 10 000 trials. Model inputs for probabilities, costs in 2020 US dollars, and quality-adjusted life-years (QALYs) were from the literature and expert consultation. The model was specifically designed to reflect the US health care system, adopting a federal payer perspective (ie, Medicare).ExposuresMagnetic resonance imaging with potential MRI-guided biopsy and standard biopsy.Main Outcomes and MeasuresIncremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $100 000 per QALY was estimated. One-way and probabilistic sensitivity analyses were performed.ResultsFor the 3 PSA strata of 2.5 ng/mL or greater, the MRI and potential MRI-guided biopsy strategy was cost-effective compared with standard biopsy (PSA 2.5-4.0 ng/mL: base-case ICER, $21 131/QALY; PSA 4.1-10.0 ng/mL: base-case ICER, $12 336/QALY; PSA &gt;10.0 ng/mL: base-case ICER, $6000/QALY). Results varied depending on the diagnostic accuracy of MRI and potential MRI-guided biopsy. Results of probabilistic sensitivity analyses showed that the MRI and potential MRI-guided biopsy strategy was cost-effective at the willingness-to-pay threshold of $100 000 per QALY in a range between 76% and 81% of simulations for each of the 3 PSA strata of 2.5 ng/mL or more.Conclusions and RelevanceThis economic evaluation of a hypothetical cohort suggests that an annual MRI and potential MRI-guided biopsy was a cost-effective option from a US federal payer perspective compared with standard biopsy for newly eligible male Medicare beneficiaries with a serum PSA level of 2.5 ng/mL or more.

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Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results

Yun,

Kim,

Gandhe

et al. 2023

JAMA Netw Open

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“…The increased experience in the diagnostic application of mpMRI has led to the standardization of result reporting in the form of the prostate imagingreporting and data system (PI-RADS) scoring method. Moreover, the inherent differentiating ability of mpMRI for csPCa has led to its introduction in the diagnostic algorithm of the European and the American guidelines [3,4].…”

Section: Introductionmentioning

confidence: 99%

The Value of Prostate-Specific Antigen Density in Combination with Lesion Diameter for the Accuracy of Prostate Cancer Prediction in Prostate Imaging-Reporting and Data System 3 Prostate Lesions

Senel,

Koudonas,

Uzun

et al. 2023

Urol Int

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Introduction: The aim of the study was to investigate the value of prostate-specific antigen density (PSAD) and lesion diameter (LD) combination in prostate cancer (PCa) detection. Methods: 181 patients who were detected to have prostate imaging-reporting and data system (PI-RADS) 3 lesions in mpMRI and underwent prostate biopsies were included in the study. Demographic, clinical, and pathological data of all patients were evaluated. The patients were divided into four groups according to PSAD and LD status (PSAD <0.15 ng/mL/cc + LD <1 cm, PSAD <0.15 ng/mL/cc + LD ≥1 cm, PSAD ≥0.15 ng/mL/cc + LD <1 cm, and PSAD ≥0.15 ng/mL/cc + LD ≥1 cm). Diagnostic ability for PCa and clinical significant PCa (csPCa) was evaluated by PSAD and LD. Results: PSAD ≥0.15 ng/mL/cc (OR = 6; 95% Cl = 2.847–12.647; p < 0.001), LD ≥1 cm (OR = 7.341; 95% confidence interval [CI] = 2.91–18.52; p < 0.001), and combination of PSAD ≥0.15 ng/mL/cc and LD ≥1 cm (OR = 10.023; 95% CI = 4.32–23.252; p < 0.001) were associated with PCa detection rates. The most sensitivity, specificity, negative, and positive predictive values were found in PSAD ≥0.15 ng/mL/cc + LD ≥1 cm group for both PCa and csPCa detection (48.8%, 92%, 85.2%, and 65.6% for any PCa detection; 66.7%, 85.2%, 97.3%, and 24.2% for csPCa detection, respectively). Conclusion: The presence of PSAD ≥0.15 ng/mL/cc or LD ≥1 cm in mpMRI of patients with PI-RADS 3 lesions is associated significantly with the finding of PCa and particularly with the detection of csPCa.

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“…The uncertainty regarding the risk of clinically significant CaP after a fusion biopsy demonstrating ASAP, given the lack of evidence in this space, is cited as the support for this recommendation. 10,11 Herein, we investigated if MRI could be used to triage which men with ASAP or multifocal HGPIN on an initial biopsy should undergo repeat biopsy and which men could return to PSA screening. Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) prostate biopsy registry, we retrospectively reviewed men with ASAP or multifocal HGPIN on initial biopsy that did or did not undergo an MRI prior to a repeat biopsy.…”

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confidence: 99%

Can MRI Help Inform Which Men With a History of Multifocal High-Grade Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation Remain at an Elevated Risk for Clinically Significant Prostate Cancer?

Sessine,

Radoiu,

et al. 2024

Journal of Urology

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Purpose: We investigated the association of MRI findings in men with a previous diagnosis of atypical small acinar proliferation (ASAP) or multifocal high-grade intraepithelial neoplasia (HGPIN) with pathologic findings on repeat biopsy. Materials and Methods: We retrospectively reviewed patients with ASAP/ multifocal HGPIN undergoing a repeat biopsy in the Michigan Urological Surgery Improvement Collaborative registry. We included men with and without an MRI after the index biopsy demonstrating ASAP/multifocal HGPIN but before the repeat biopsy. Men with an MRI prior to the index biopsy were excluded. We compared the proportion of men with GG2 CaP (Grade Group 2 prostate cancer) on repeat biopsy among the following groups with the c 2 test: no MRI, PIRADS (Prostate ImagingeReporting and Data System) 4, and PIRADS 3. Multivariable models were used to estimate the adjusted association between MRI findings and GG2 CaP on repeat biopsy. Results: Among the 207 men with a previous diagnosis of ASAP/multifocal HGPIN that underwent a repeat biopsy, men with a PIRADS 4 lesion had a higher proportion of GG2 CaP (56%) compared with men without an MRI (12%, P < .001). A lower proportion of men with PIRADS 3 lesions had GG2 CaP (3.0%) compared with men without an MRI (12%, P [ .13). In the adjusted model, men with a PIRADS 4 to 5 lesion had higher odds (OR: 11.4, P < .001) of GG2 CaP on repeat biopsy. Conclusions: MRI is a valuable diagnostic tool to triage which men with a history of ASAP or multifocal HGPIN on initial biopsy should undergo or avoid repeat biopsy without missing clinically significant CaP.

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Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy

Cited by 52 publications

References 49 publications

Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results

Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results

The Value of Prostate-Specific Antigen Density in Combination with Lesion Diameter for the Accuracy of Prostate Cancer Prediction in Prostate Imaging-Reporting and Data System 3 Prostate Lesions

Can MRI Help Inform Which Men With a History of Multifocal High-Grade Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation Remain at an Elevated Risk for Clinically Significant Prostate Cancer?

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