The value of prostate-specific antigen density for prostate imaging-reporting and data system 3 lesions on multiparametric magnetic resonance imaging

• Verfasst von: Görtz, Magdalena [VerfasserIn]
• Verfasst von: Radtke, Jan Philipp [VerfasserIn]
• Verfasst von: Hatiboglu, Gencay [VerfasserIn]
• Verfasst von: Schütz, Viktoria [VerfasserIn]
• Verfasst von: Tosev, Georgi [VerfasserIn]
• Verfasst von: Güttlein, Maximilian [VerfasserIn]
• Verfasst von: Leichsenring, Jonas [VerfasserIn]
• Verfasst von: Stenzinger, Albrecht [VerfasserIn]
• Verfasst von: Bonekamp, David [VerfasserIn]
• Verfasst von: Schlemmer, Heinz-Peter [VerfasserIn]
• Verfasst von: Hohenfellner, Markus [VerfasserIn]
• Verfasst von: Nyarangi-Dix, Joanne [VerfasserIn]
• Titel: The value of prostate-specific antigen density for prostate imaging-reporting and data system 3 lesions on multiparametric magnetic resonance imaging
• Titelzusatz: a strategy to avoid unnecessary prostate biopsies
• Verf.angabe: Magdalena Görtz, Jan Philipp Radtke, Gencay Hatiboglu, Viktoria Schütz, Georgi Tosev, Maximilian Güttlein, Jonas Leichsenring, Albrecht Stenzinger, David Bonekamp, Heinz-Peter Schlemmer, Markus Hohenfellner, Joanne Nyaboe Nyarangi-Dix
• E-Jahr: 2019
• Jahr: 12 December 2019
• Fussnoten: Gesehen am 28.04.2020
• Titel Quelle: Enthalten in: European urology focus
• Ort Quelle: Amsterdam : Elsevier, 2015
• Jahr Quelle: 2021
• Band/Heft Quelle: 7(2021), 2, Seite 325-331
• ISSN Quelle: 2405-4569
• DOI: doi:10.1016/j.euf.2019.11.012
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Fusion biopsy
• Sach-SW: Magnetic resonance imaging
• Sach-SW: Prostate cancer
• Sach-SW: Prostate Imaging-Reporting and Data System
• Sach-SW: Prostate-specific antigen density
• K10plus-PPN: 1696284147

Abstract

Background - Multiparametric magnetic resonance imaging (mpMRI) has excellent sensitivity in detecting significant prostate cancer (sPC). Nevertheless, uncertainty exists regarding the management of Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions. - Objective - To investigate whether PI-RADS 3 lesions in combination with clinical parameters, especially prostate-specific antigen density (PSAD), can be used to exclude sPC. - Design, setting, and participants - A total of 455 consecutive biopsy-naïve men underwent MRI-guided transperineal prostate fusion biopsy at our department between 2017 and 2018. We identified 101 patients who had exclusively one or more PI-RADS 3 lesions on mpMRI. sPC was defined as intermediate- and high-risk PC (according to the D’Amico risk classification). - Outcome measures and statistical analysis - Univariate logistic regression analysis was performed to test different clinical factors as predictors of sPC in men with PI-RADS 3 lesions. The probability of sPC prediction was calculated for different PSAD thresholds. - Results and limitations - Among patients with PI-RADS 3 lesions, PSAD was a significant predictor of sPC (p = 0.005). For a PI-RADS score of 3 the probability of excluding sPC was 85% (86/101), which increased to 98% (42/43) when combined with PSAD <0.1 ng/ml/ml. - Conclusions - Inclusion of PSAD < 0.1 ng/ml/ml in the strategy for biopsy-naïve patients with equivocal mpMRI findings would allow a reduction in prostate biopsies in 43% (43/101) of cases at the cost of missing a very small number (2%, 1/43) of intermediate-risk PCs. - Patient summary - At high-volume tertiary care centers with significant experience in prostate multiparametric magnetic resonance imaging, immediate biopsies could be safely omitted for men with lesions with a Prostate Imaging-Reporting and Data System score of 3 and prostate-specific antigen density of PSAD < 0.1 ng/ml/ml. Any decision to omit an immediate biopsy should be associated with close monitoring.