PD57-02 ASSESSMENT OF CLINICAL UTILITY OF PSA DENSITY IN RISK STRATIFICATION OF PI-RADS V2.1 CATEGORIES ON PROSTATE MRI

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You have accessJournal of UrologyCME1 May 2022PD57-02 ASSESSMENT OF CLINICAL UTILITY OF PSA DENSITY IN RISK STRATIFICATION OF PI-RADS V2.1 CATEGORIES ON PROSTATE MRI Gianluca Giannarini, Rossano Girometti, Valeria Panebianco, Silvio Maresca, Lorenzo Cereser, Maria De Martino, Stefano Pizzolitto, Vincenzo Ficarra, Chiara Zuiani, and Claudio Valotto Gianluca GiannariniGianluca Giannarini More articles by this author , Rossano GiromettiRossano Girometti More articles by this author , Valeria PanebiancoValeria Panebianco More articles by this author , Silvio MarescaSilvio Maresca More articles by this author , Lorenzo CereserLorenzo Cereser More articles by this author , Maria De MartinoMaria De Martino More articles by this author , Stefano PizzolittoStefano Pizzolitto More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , Chiara ZuianiChiara Zuiani More articles by this author , and Claudio ValottoClaudio Valotto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002637.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the advent of the novel MRI-based pathway for prostate cancer (PCa) detection, there is intense research to implement risk-adjusted strategies for the proper selection of biopsy patients and the reduction of false-negative results. In this study we investigated the clinical utility of different thresholds of PSA density (PSAD) in improving the accuracy of Prostate Imaging – Reporting And Data System version 2.1 (PI-RADS v2.1) categories for detecting clinically significant PCa on multiparametric MRI (mpMRI) and mpMRI-targeted and systematic biopsy. METHODS: A total of 123 consecutive biopsy-naïve men referred to mpMRI and prostate biopsy between April 2019 and October 2020 were retrospectively analysed. mpMRI was performed on a 3.0T magnet with a 32-channel surface coil, using a PI-RADS v2.1-compliant protocol. Two readers (>1500 and >500 mpMRI examinations) were included. All patients underwent transperineal mpMRI-targeted and systematic prostate biopsy. Clinically significant PCa was defined as International Society of Urogenital Pathology grading group ≥2 on combined biopsy. Analysis was performed on a per-index lesion basis. Receiver operating characteristic analysis was used to calculate sensitivity, specificity, and area under the curve (AUC) of PI-RADS v2.1 categories after adjusting for different PSAD thresholds (≥0.10, ≥0.15, and ≥0.20 ng/mL/mL). Cancer detection rate (CDR) was calculated on a per-adjusted category basis, and decision analysis was performed to assess the net benefit of different PSAD-adjusted PI-RADS v2.1 categories as a biopsy trigger. RESULTS: Clinically significant PCa was found in 54/123 men (43.9%; 95%CI 40.5-70.4). PSAD-adjustment increased the CDR of PI-RADS v2.1 category 4 regardless of the threshold. Sensitivity/specificity/AUC were 92.6%/53.6%/0.82 for unadjusted PI-RADS, and 85.2%/72.4%/0.84, 62.9%/85.5%/0.83, and 92.4%/53.6%/0.82 when adjusting PIRADS categories for a 0.10, 0.15, and 0.20 ng/ml/ml PSAD threshold, respectively. The greatest net benefit at 30% and 40% risk probability of clinically significant PCa (0.307 and 0.271, respectively) was observed assuming biopsy patients with a PI-RADS 4 observation and PSAD ≥0.10 ng/mL/mL. CONCLUSIONS: Within the range of expected prevalence for clinically significant PCa, decision analysis showed that PI-RADS v2.1 category 4 with high PSAD at the 0.10 ng/mL/mL threshold was the biopsy-triggering cut-off with the highest net benefit. If confirmed in larger prospective studies, our results might emphasize the concept that the combination of lower PSAD threshold and higher PI-RADS v2.1 cut-off may allow for better risk stratification of men referred to prostate biopsy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e959 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gianluca Giannarini More articles by this author Rossano Girometti More articles by this author Valeria Panebianco More articles by this author Silvio Maresca More articles by this author Lorenzo Cereser More articles by this author Maria De Martino More articles by this author Stefano Pizzolitto More articles by this author Vincenzo Ficarra More articles by this author Chiara Zuiani More articles by this author Claudio Valotto More articles by this author Expand All Advertisement PDF DownloadLoading ...