Role of mpMRI PSA Density and PI-RADS Score in Predicting Upstaging in Men on Active Surveillance

Abstract

PurposeUsing a combination of magnetic resonance imaging of the prostate and prostate specific antigen density, we aim to determine which men on active surveillance are at risk of being upstaged, and which men could avoid repeat biopsy while remaining on surveillance. MethodsWe reviewed 110 men on active surveillance with Gleason 6 disease who underwent magnetic resonance imaging followed by Uronav-fusion biopsy. Using univariable and multivariable logistic regression analyses, we examined the effect of age, race, prostate specific antigen, prostate specific antigen density, prostate volume, Prostate Imaging - Reporting and Data System (PI-RADS) score, number and size of target lesions, and time on surveillance to determine the likelihood of upstaging to Gleason ≥7 disease. ResultsA total of 33 men, or 30%, were upstaged. On multivariable analysis, prostate specific antigen density and PI-RADS score were significant predictors of upstaging with adjusted odds ratios of 3.97 for prostate specific antigen density of ≥0.16 (CI 1.31-12.00, p<0.05), 13.8 for a PI-RADS 4 lesion (CI 2.3-81.3, p<0.01), and 25 for a PI-RADS 5 lesion (CI 3.8-163.5, p<0.01). When cross-tabulating these factors, men with a PI-RADS score of ≥3 with a prostate specific antigen density of ≥0.16 had a 61.2% chance of upstaging. Conversely, in men with PI-RADS score ≤3 and prostate specific antigen density <0.15, no upstaging was seen. ConclusionA combination of PI-RADS score and prostate specific antigen density predicts patients at risk of being upstaged at surveillance biopsy. Conversely, this combination may help determine which men may safely forgo biopsy.