Magnetic Resonance Imaging-Defined Prostate-Specific Antigen Density Significantly Improves the Risk Prediction for Clinically Significant Prostate Cancer on Biopsy

“…Published studies suggest that further refinements of MRI criteria could be used to identify men in this subgroup who are more likely to harbor cancers by including the number of sequences with which abnormalities are visible (64), by using patterns of contrast enhancement that are not currently codified within the PI-RADS system (65), or by using apparent diffusion coefficient measurements. As previously noted, multiple publications have shown that clinical factors, including PSA density (11,20,42,47,49), risk calculators (19,56), and other serum biomarkers (24), can help determine which men with PI-RADS category 3 findings have higher probability of having clinically significant cancers.…”

Section: Combining Mri Results With Clinical Parametersmentioning

confidence: 94%

“…ables for biopsy avoidance in most PI-RADS category 2 cases and in some PI-RADS category 3 cases suggests that PSA density, family history, other biomarkers (24,45), and risk calculator scores (15,20) may be helpful (46). Several investigators found that lower PSA density improves the negative predictive value of MRI (11,33,42,(47)(48)(49). For example, Hansen et al noted that the negative predictive value for clinically significant cancer was better for patient subcohorts with lower PSA density (0.1 ng/mL/cm 3 ), where the negative predictive value increased from 80% to 91% for ISUP grade group 2 or higher tumors (47).…”

Section: Key Pointsmentioning

confidence: 99%

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Padhani¹,

Barentsz²,

Villeirs³

et al. 2019

Radiology

187

118

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he current version of the Prostate Imaging Reporting and Data System (PI-RADS) was formulated on experience gained from PI-RADS version 1, accumulated scientific evidence, and expert consensus (1). The release of PI-RADS version 2.1 is expected to further improve observer variability (2). A recent publication evaluated multiple clinical studies, systematic analyses, and professional guidelines on their use of multiparametric MRI in prostate cancer detection (3). It showed that the test performance of multiparametric MRI-directed biopsy in the detection of prostate cancer is superior to that of systematic transrectal US-guided biopsy. High-level evidence has now established multiple benefits of MRI-directed biopsy over systematic transrectal US-guided biopsy of the prostate (4). These benefits include (a) a reduction in the number of men who need to undergo biopsy (5-9); (b) a reduction in the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm (4,10), with the potential to reduce overtreatment, treatment-related complications, and active surveillance rates (6); (c) improved detection of clinically significant prostate cancers, particularly in patients with prior negative transrectal US-guided biopsy findings (4,10); and (d) improved risk stratification of diagnosed cancers owing to greater precision in tumor grade and volume determinations, which helps direct disease management. All these advantages can be achieved with fewer targeted biopsy cores per patient, potentially reducing biopsy-related morbidity (6,8,11). The purpose of this article is to focus on how multiparametric MRI results can positively impact the health of men suspected of having clinically significant prostate cancer. Who Should Undergo MRI before Biopsy? Patients chosen for MRI before biopsy include biopsynaive men with elevated serum prostate-specific antigen (PSA) levels, abnormal digital rectal examination findings, or both, and men who are deemed to have persistent elevated risk of harboring clinically significant cancers despite prior negative or nonexplanatory systematic transrectal US biopsy findings. Indications for MRI should be based on the recommendations for screening and early diagnosis of the National Comprehensive Cancer Network and the European Association of Urology (12,13). Accordingly, biopsy-naive men with lower than average risk of prostate cancer should not undergo prostate biopsy or MRI. However, limiting the options to prespecified PSA thresholds is not recommended, as there are many factors (eg, symptoms, age, race, family history, PSA kinetics, digital rectal examination findings) that in

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“…PSAD was an independent predictor of reclassification using 0.20 as cut-off. Furthermore, Bhat et al showed that none of the patients in active surveillance presented a risk of disease reclassification in case of PI-RADS scores of 1 to 3 and PSAD 0.15 ng/mL/cc as upper limit (14). PSAD might spare some men from the morbidity associated with a prostate biopsy and diagnosis of low-grade prostate cancer, therefore should be included in the flow-chart of prostate cancer diagnosis.…”

Section: Psa Velocitymentioning

confidence: 99%

Detection limits of significant prostate cancer using multiparametric MR and digital rectal examination in men with low serum PSA: Up-date of the Italian Society of Integrated Diagnostic in Urology

Galosi

Palagonia

Scarcella

et al. 2021

Arch Ital Urol Androl

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Reasons why significant prostate cancer is still missed in early stage were investigated at the 22nd National SIEUN (Italian Society of integrated diagnostic in Urology, Andrology, Nephrology) congress took place from 30th November to 1st December 2020, in virtual modality. Even if multiparametric magnetic resonance (MR) has been introduced in the clinical practice several, limitations are emerging in patient with regular digital rectal examination (DRE) and serum prostate specific antigen (PSA) levels approaching the normal limits. The present paper summarizes highlights observed in those cases where significant prostate cancer may be missed by PSA or imaging and DRE. The issue of multidisciplinary interest had been subdivided and deepened under four main topics: biochemical, clinical, pathological and radiological point of view with a focus on PI-RADS 3 lesions.

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Magnetic Resonance Imaging-Defined Prostate-Specific Antigen Density Significantly Improves the Risk Prediction for Clinically Significant Prostate Cancer on Biopsy

Cited by 32 publications

References 20 publications

The value of a first MRI and targeted biopsies after several years of active surveillance for low-risk prostate cancer – results from the SAMS trial

The value of a first MRI and targeted biopsies after several years of active surveillance for low-risk prostate cancer – results from the SAMS trial

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Detection limits of significant prostate cancer using multiparametric MR and digital rectal examination in men with low serum PSA: Up-date of the Italian Society of Integrated Diagnostic in Urology

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