Multi‐institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI‐RADS 3 lesions

Abstract

BACKGROUND: Most Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions do not contain clinically significant prostate cancer (CSPCa; grade group ≥2). This study was aimed at identifying clinical and magnetic resonance imaging (MRI)-derived risk factors that predict CSPCa in men with PI-RADS 3 lesions. METHODS: This study analyzed the detection of CSPCa in men who underwent MRI-targeted biopsy for PI-RADS 3 lesions. Multivariable logistic regression models with goodness-of-fit testing were used to identify variables associated with CSPCa. Receiver operating curves and decision curve analyses were used to estimate the clinical utility of a predictive model. RESULTS: Of the 1784 men reviewed, 1537 were included in the training cohort, and 247 were included in the validation cohort. The 309 men with CSPCa (17.3%) were older, had a higher prostate-specific antigen (PSA) density, and had a greater likelihood of an anteriorly located lesion than men without CSPCa (p < .01). Multivariable analysis revealed that PSA density (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.05-1.85; p < .01), age (OR, 1.05; 95% CI, 1.02-1.07; p < .01), and a biopsy-naive status (OR, 1.83; 95% CI, 1.38-2.44) were independently associated with CSPCa. A prior negative biopsy was negatively associated (OR, 0.35; 95% CI, 0.24-0.50; p < .01). The application of the model to the validation cohort resulted in an area under the curve of 0.78. A predicted risk threshold of 12% could have prevented 25% of biopsies while detecting almost 95% of CSPCas with a sensitivity of 94% and a specificity of 34%. CONCLUSIONS: For PI-RADS 3 lesions, an elevated PSA density, older age, and a biopsy-naive status were associated with CSPCa, whereas a prior negative biopsy was negatively associated. A predictive model could prevent PI-RADS 3 biopsies while missing few CSPCas.

Micro‐ultrasound may significantly reduce the proportion of unnecessary prostate biopsies in patients with PI‐RADS 3 lesions

“…Pier Paolo Avolio MD 1,2 Massimo Lazzeri MD, PhD 2 Nicolò Maria Buffi MD 1,2 Giovanni Lughezzani MD 1,2…”

“…

We read with great interest the recent report by Fang et al 1 The authors investigated the use of clinical factors in predicting clinically significant prostate cancer (csPCa) in men with equivocal lesions on multiparametric magnetic resonance imaging (mpMRI).

More specifically, the article focuses on individuals with ProstateImaging-Reporting and Data System (PI-RADS) 3 lesions on mpMRI and discusses the role of targeted and systematic biopsies in this patient category.The authors found that a predictive model including the prostate-specific antigen density, age, and biopsy history could prevent 25% of PI-RADS 3 biopsies while missing approximately 5% of csPCa cases. Interestingly, the authors reported that an anterior lesion location represented an important predictor of cancer in PI-RADS 3 lesions but did not significantly improve the overall performance of their model.

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“…We read with great interest the recent report by Fang et al 1 The authors investigated the use of clinical factors in predicting clinically significant prostate cancer (csPCa) in men with equivocal lesions on multiparametric magnetic resonance imaging (mpMRI).…”

Efficacy of plasma atherogenic index in predicting malignancy in the presence of Prostate Imaging–Reporting and Data System 3 (PI-RADS 3) prostate lesions

“…The results of the above meta-analysis are also adopted by the EAU Guidelines. Another report on the detection of csPSA among PI-RADS 3 lesions concluded that an elevated PSAD value, older age, and biopsy-naïve status retain an independent predictive value in the multivariate analysis of the study (Fang et al 2022). Lesion volume comprises another factor that can discriminate the signi cant PI-RADS 3 lesions.…”

Reply to “Micro‐ultrasound may significantly reduce the proportion of unnecessary prostate biopsies in patients with PI‐RADS 3 lesions”

“…We thank Avolio and colleagues for their comments regarding our multi-institutional study investigating the clinical parameters that can optimize the interpretation and biopsy decision-making algorithm for men with a Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesion on multiparametric magnetic resonance imaging (MRI) studies. 1 We greatly appreciate their insight and expertise concerning the potential for integrating high-resolution micro-ultrasound (micro-US) into the workflow of prostate cancer screening and biopsy targeting and its use as an adjunct tool to further optimize the diagnosis of clinically significant prostate cancers. 2 In our investigation, we acknowledge that such advanced ultrasound technology was not widely available or used by the majority of the contributing institutions during the time frame examined, so it was not integrated into the data set and analysis.…”