Use of Prostate Specific Antigen Density Combined with Multiparametric Magnetic Resonance Imaging Improves Triage for Prostate Biopsy.

Multi-parametric magnetic resonance imaging (mpMRI)-directed biopsy for prostate cancer (PC) diagnosis improves the detection of clinically significant prostate cancer (CSPC) and decreases the rate of over-diagnosis of insignificant disease. The aim of this study was to investigate the value of mpMRI combined with prostate specific antigen density (PSAD) in the decision making related to the biopsy.

mpMRI and mpMRI/transrectal ultrasound fusion targeted biopsies with subsequent systematic biopsies were performed in 397 patients (223 biopsy-naïve and 174 with a previous biopsy). Detection rates of (CSPC) and insignificant PC were stratified using the PIRADS score, and the number of avoidable biopsies and missed (CSPC) were plotted against PSAD values of 0.1-0.5 ng/mL2.

PIRADS <3 and PSAD <0.2 ng/mL2 were the safest criteria for not performing a biopsy. When applied to the biopsy-naïve group, 21.5% (48/223) of the biopsies could have been avoided and 3.7% (3/82) of CSPC would have been missed. In the repeat biopsy group, 12.6% (22/174) of biopsies could have been avoided and 6.9% (4/58) of (CSPC) would have been missed.

A combination of mpMRI and PSAD might reduce the number of biopsies performed with the cost of missing <4% of CSPC.

Urologia internationalis. 2019 May 08 [Epub ahead of print]

Miroslav Záleský, Jiri Stejskal, Vanda Adamcova, Jan Hrbáček, Ivo Minarik, Adam Pavlicko, Jana Votrubova, Marek Babjuk, Roman Zachoval

Department of Urology, Thomayer Hospital, Prague, Czechia., 2nd Faculty of Medicine, Department of Urology, Charles University, Prague, Czechia., Department of Radiology, Thomayer Hospital, Prague, Czechia., Department of Urology, Thomayer Hospital, Prague, Czechia, .