Data from Risk of Clinically Significant Prostate Cancer after a Nonsuspicious Prostate MRI—A Comparison with the General Population

Abstract

<div>AbstractBackground:<p>We compare the risk of clinically significant (csPCa; ISUP Grade Group ≥ 2) and insignificant prostate cancer (isPCa; ISUP Grade Group 1) in men with a nonsuspicious prostate MRI (nMRI; PI-RADS ≤ 2) with the general population, and assess the value of PSA density (PSAD) in stratification.</p>Methods:<p>In this retrospective population-based cohort study we identified 1,682 50–79-year-old men, who underwent nMRI at HUS (2016–2019). We compared their age-standardized incidence rates (IR) of csPCa and the odds of isPCa to a local age- and sex-matched general population (<i>n</i> = 230,458) during a six-year follow-up. Comparisons were performed by calculating incidence rate ratios (IRR) and ORs with 95% confidence intervals (CI). We repeated the comparison for the 920 men with nMRI and PSAD < 0.15 ng/mL/cm<sup>3</sup>.</p>Results:<p>Compared with the general population, the IR of csPCa was significantly higher after nMRI [1,852 vs. 552 per 100,000 person-years; IRR 3.4 (95% CI, 2.8–4.1)]. However, the IR was substantially lower if PSAD was low [778 per 100,000 person-years; IRR 1.4 (95% CI, 0.9–2.0)]. ORs for isPCa were 2.4 (95% CI, 1.7–3.5) for all men with nMRI and 5.0 (95% CI, 2.8–9.1) if PSAD was low.</p>Conclusions:<p>Compared with the general population, the risk of csPCa is not negligible after nMRI. However, men with nMRI and PSAD <0.15 ng/mL/cm<sup>3</sup> have worse harm-benefit balance than men in the general population.</p>Impact:<p>Prostate biopsies for men with nMRI should be reserved for cases indicated by additional risk stratification.</p><p><i><a href="https://aacrjournals.org/cebp/article/doi/10.1158/1055-9965.EPI-24-0214" target="_blank">See related In the Spotlight, p. 641</a></i></p></div>