Median Prostate Specific Antigen Density Research Articles

PI-RADS in Predicting csPCa: A Comparison Between Academic and Nonacademic Centers.

The introduction of multiparametric prostate magnetic resonance imaging (mpMRI) has revolutionized prostate cancer (PCa) diagnosis, enhancing the localization of clinically significant prostate cancer (csPCa) and guiding targeted biopsies. However, significant disparities in the execution, interpretation, and reporting of prostate MRI examinations across centers necessitate greater standardization and accuracy. This study compares the diagnostic efficacy of mpMRI from academic and nonacademic centers in detecting csPCa and identifies factors associated with csPCa detection. Between July 2018 and October 2023, we prospectively followed 810 men at SS. Annunziata Hospital of Chieti who underwent MRI/US fusion biopsies due to elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). Patients with mpMRI-documented suspicious lesions classified as PI-RADS ≥ 3 were included. Patients were divided into two groups based on the source of their mpMRI (academic or nonacademic centers). All biopsies were conducted using the MRI/US fusion technique. Clinical, mpMRI, and pathological data were collected and analyzed. Statistical analyses were performed using R software. The cohort included 354 patients from academic centers and 456 from nonacademic centers. There were no significant differences in patient demographics, such as age and PSA levels, between the groups. Patients at academic centers were more likely to receive a higher number of elevated PI-RADS scores compared to those at nonacademic centers (PI-RADS > 3: 72.6% vs. 62.3%, p = 0.003). Histopathological analysis revealed no significant differences in the ISUP grade distribution between groups. Increased age, PSA levels, and positive DRE were significantly associated with higher odds of detecting csPCa. Median PSA density was significantly higher in patients with csPCa compared to those without csPCa (0.14 vs. 0.11 ng/mL/cm³, p < 0.001). Academic centers exhibited a higher odds ratio for csPCa detection in patients with PI-RADS scores > 3 compared to nonacademic centers. Our study highlights significant variability in PI-RADS score assignments between academic and nonacademic centers, affecting csPCa detection rates. This variability underscores the need for greater standardization in PI-RADS scoring to reduce disparities and improve diagnostic uniformity across centers.

Radical prostatectomy without prostate biopsy based on a noninvasive diagnostic strategy: a prospective single-center study.

Prostate biopsy is the most common approach for diagnosing prostate cancer (PCa); however, it has inherent limitations, such as the invasive procedure, postoperative complications, and false negative results. We aimed to provide a noninvasive diagnostic strategy for patients with highly suspected PCa and to evaluate the feasibility of performing biopsy-spared radical prostatectomy. This prospective study included a total of 57 patients between November 10, 2022, and December 1, 2023. All 57 patients underwent radical prostatectomy without prior prostate biopsy based on a noninvasive diagnostic strategy consisting of a diagnostic prediction model [comprised of the prostate imaging-reporting and data system (PI-RADS) score and prostate-specific antigen density (PSAD)] and the 18F-prostate-specific membrane antigen (PSMA)-1007 positron emission tomography (PET)/computed tomography (CT) examination. The primary endpoint was the positive predictive value (PPV) of clinically significant PCa [the International Society of Urological Pathology (ISUP) grade ≥2, Gleason score ≥3 + 4]. The secondary endpoints were a PPV of any-grade PCa (ISUP grade ≥ 1, Gleason score ≥3 + 3) and high-grade PCa (ISUP grade ≥3, Gleason score ≥4 + 3), and the false positive rate of the diagnostic strategy. Of the 371 screened patients with clinically suspected PCa, 57 patients fulfilled the criteria and consented to participate in this study. The median PSAD level was 0.56 (0.42-0.82) ng/mL2; 13 (22.8%) patients were identified as having a PI-RADS score of 4, and 44 (77.2%) patients with a PI-RADS score of 5. The median SUVmax of 18F-PSMA-1007 PET/CT was 21.6 (15.8-33.0). For the 57 enrolled patients who received radical prostatectomy directly, the PPV of clinically significant PCa was 98.2% [56/57, 95% confidence interval (CI): 90.6-100%]. Only 1.8% (1/57, 95% CI: 0.0-9.4%) of patients were diagnosed with clinically insignificant PCa (ISUP grade = 1, Gleason score = 3 + 3). The PPV of any-grade PCa and high-grade PCa were 100% and 73.7% (42/57, 95% CI: 60.3-84.5%), respectively. No one had a false positive result. We proposed a noninvasive diagnostic strategy consisting sequentially of a diagnostic prediction model and the 18F-PSMA-1007 PET/CT examination for diagnosing PCa. Despite some limitations, our initial findings suggest the potential feasibility of radical prostatectomy without prior prostate biopsy.

Comparison of the incidence of clinically significant prostate cancer in patients with isolated peripheral versus transitional zone PIRADS 3 lesions.

We sought to investigate the association between isolated PIRADS 3 lesions of the transitional zone (TZ) versus the peripheral zone (PZ) and the incidence of clinically significant prostate cancer (csPCa) on systematic and targeted prostate biopsy (SB, TB). We retrospectively reviewed our tertiary institutional database of patients who underwent mpMRI-fusion followed by TB + SB between 2016 and 2021. We compared the incidence of csPCa (Gleason Grade Group ⩾ 2) in patients with solitary TZ-only PIRADS 3 and PZ-only PIRADS 3 on SB and TB. We excluded patients with (1)known PCa, (2)PIRADS 4-5 and/or (3)lesions in both TZ and PZ. T-tests, Chi-square tests, were conducted to compare between the groups. Of 1913 patients, we identified 110 with PZ-only and 38 with TZ-only PIRADS 3 lesions. 73 patients in PZ-only and 19 in TZ-only met inclusion criteria. No statistically significant differences were observed between PZ and TZ groups in terms of age, median prostate-specific antigen (PSA), prostate volume, median PSA-density, or median number of targeted cores obtained, all with p > 0.05.On SB, the incidence of csPCA was higher in patients with PZ rather than TZ PIRADS-3 lesions (10/73 vs 1/19, p = 0.28). Similarly, csPCA was more common in TB of PZ versus TZ PIRADS 3 lesions (7/73 vs 0/19, p = 0.33). Based on these results, the positive predictive values of PIRADS3 as a marker of csPCA were 5.3% and 0% for TZ lesions on SB versus TB, respectively, compared to 17.7% and 9.6% in the PZ. PIRADS 3 lesions are rarely associated with csPCA on SB and TB, particularly when located in the TZ, which is an important factor to consider when deciding on a biopsy in patients with isolated TZ lesions.

Outcomes of active surveillance for Japanese patients with prostate cancer (PRIAS-JAPAN).

To report the outcomes of repeat biopsies, metastasis and survival in the Prostate Cancer Research International: Active Surveillance (PRIAS)-JAPAN study, a prospective observational study for Japanese patients, initiated in 2010. At the beginning,inclusion criteria were initially low-risk patients, prostate-specific antigen (PSA) density (PSAD) <0.2, and ≤2 positive biopsy cores. As from 2014, GS3+4 has also been allowed for patients aged 70 years and over. Since January 2021, the age limit for Gleason score (GS) 3 + 4 cases was removed, and eligibility criteria were expanded to PSA ≤20 ng/mL, PSAD <0.25 nd/mL/cc, unlimited number of positive GS 3 + 3 cores, and positive results for fewer than half of the total number of cores for GS 3 + 4 cases if magnetic resonance imaging fusion biopsy was performed at study enrolment or subsequent follow-up. For patients eligible for active surveillance, PSA tests were performed every 3 months, rectal examination every 6 months, and biopsies at 1, 4, 7 and 10 years, followed by every 5 years thereafter. Patients with confirmed pathological reclassification were recommended for secondary treatments. As of February 2024, 1302 patients were enrolled in AS; 1274 (98%) met the eligibility criteria. The median (interquartile range) age, PSA level, PSAD, and number of positive cores were 69 (64-73) years, 5.3 (4.5-6.6) ng/mL, 0.15 (0.12-0.17) ng/mL, and 1 (1-2), respectively. The clinical stage was T1c in 1089 patients (86%) and T2 in 185 (15%). The rates of acceptance by patients for the first, second, third and fourth re-biopsies were 83%, 64%, 41% and 22%, respectively. The pathological reclassification rates for the first, second, third and fourth re-biopsies were 29%, 30%, 35% and 25%, respectively. The 1-, 5- and 10-year persistence rates were 77%, 45% and 23%, respectively. Six patients developed metastasis, and one patient died from prostate cancer. Pathological reclassification was observed in approximately 30% of the patients during biopsy; however, biopsy acceptance rates decreased over time. Although metastasis occurred in six patients, only one death from prostate cancer was recorded.

Clinically Significant Prostate Cancer Detection Following Transrectal and Transperineal Biopsy: Results of the Prostate Biopsy Efficacy and Complications Randomized Clinical Trial.

The comparative effectiveness of transrectal and transperineal prostate biopsy in detecting clinically significant prostate cancer is not well understood. We conducted a randomized clinical trial to determine whether transperineal biopsy improves the detection of clinically significant prostate cancer. Of the 840 men randomized, 93% were White, 44% had a previous biopsy, with a median age of 66 years and median PSA density of 0.14. Of these, 384 underwent transrectal and 398 underwent transperineal prostate biopsy. Prebiopsy prostate MRI was performed in 96% of men. Grade Group ≥ 2 prostate cancer was classified as clinically significant. Odds ratios were calculated using logistic regression to evaluate the effect of biopsy procedures on cancer detection rates. The detection rates of clinically significant prostate cancer were 47.1% and 43.2% (odds ratio 1.17; 95% CI, 0.88-1.55) for transrectal and transperineal biopsy, respectively. Age, PSA density, clinical stage and Prostate Imaging Reporting and Data System score were associated with the diagnosis of clinically significant cancer, whereas history of previous biopsy, anterior tumors, and biopsy procedure (transrectal or transperineal) were not. Clinically significant cancer detection rates in biopsy-naïve men undergoing MRI-targeted transrectal or transperineal biopsy were 59% and 62%, respectively. The overall cancer detection rates following transrectal and transperineal biopsy were 72.1% and 70.4%, respectively. There was no significant difference noted in the detection of clinically significant prostate cancer following transrectal or transperineal prostate biopsy. Urologists may utilize either biopsy procedure that best suits their patients' needs and practice setting.

Negative magnetic resonance imaging cannot be used to omit an initial prostate biopsy - An ambispective study

IntroductionUp to 40% of patients with suspected prostate cancer (PCa) have a negative prebiopsy magnetic resonance imaging (nMRI), and up to 15% of them may have clinically significant PCa (csPCa). The ability to predict the presence of csPCa despite nMRI may help avoid unnecessary biopsies. We aimed to determine the negative predictive value (NPV) of mpMRI, the influence of MRI reporting patterns in clinical practice, and the factors that might predict csPCa among men with an nMRI. MethodologyIn an IRB-approved, ambispective study, men who underwent prostate biopsy from 2016 to 2023 and had a prebiopsy MRI, were included to determine the presence of csPCa. The reporting patterns of institutional and noninstitutional MRI were evaluated. Age, digital rectal examination (DRE) findings, prostate specific antigen (PSA), PSA density (PSAD), and MRI reports were evaluated for their ability to predict csPCa in men with nMRI. Results1660 patients who underwent prostate biopsy were assessed for eligibility, and 685 patients were enrolled in the study. The median age, PSA and PSAD were 60 years, 11.63 ng/ml and 0.23 ng/ml/cm3, respectively. 62 (9%) men had an nMRI, among which csPCa, non-csPCa, and negative biopsy were found in 34%, 5%, and 61% of men, respectively. 61% had an institutional MRI, while 39% had a noninstitutional MRI. The sensitivity and NPV of any MRI for csPCa were 93% and 66%, respectively, which improved to 96% and 81% for institutional MRI. Univariate and multivariate analyses showed abnormal DRE and PSAD ≥0.25 ng/ml/cc as predictive factors for csPCa in men with an nMRI. Conclusion34% of men with negative MRIs were found to harbor csPCa on prostate biopsy. The NPV of institutional MRI was higher than for noninstitutional MRI. Men with an abnormal DRE or PSAD ≥0.25 ng/ml/cc had a higher incidence of csPCa despite an nMRI.

PSA density as a predictor of long-term infectious complications during transurethral resection of the prostate: determining an optimal cut-off value

Introduction. Infectious complications (ICs) after transurethral resection of the prostate (TURP) are significant and potentially life-threatening conditions with an incidence 0.5% – 20.0%. Most publications provide data regarding early infectious complications. At the same time, there are currently no studies aimed at a comprehensive assessment of long-term infectious complications after TURP. The problem of prevention and treatment of ICs is also accompanied by insufficient understanding of the role of undiagnosed inflammation in prostate tissues and the lack of representative laboratory markers.Objective. To assess the prostate-specific antigen density (PSAd) as a predictor of long-term infectious complications after transurethral resection of the prostate and to determine the optimal cut-off value.Materials &amp; methods. This single-center study included 162 patients who underwent mono- and bipolar TURP between 2016 – 2023. Inclusion criteria for the study: prostate volume 30–80 cm3, no history of urinary tract infections (UTIs) at the time of hospitalization and antibiotic treatment at least one month before surgery, possible presence of latent UTIs before surgery, no prostate cancer. Exclusion criteria were failure to meet inclusion criteria. Infectious complications assessed included upper and lower UTIs, as well as epididymitis, orchitis and prostatitis, confirmed by clinical and laboratory data. Prostate-specific antigen (PSA) assessment was performed &lt; 2 days before surgery.Results. The median PSAd value was 0.04 [0.03; 0.08] ng/ml2, the variable was significantly different in non-infection and infection groups (0.04 and 0.08 ng/ml2, respectively, p = 0.009). The area under the curve (AUC) was 0.67 (95% CI [0.546 – 0.791]). The optimal cut-off value of the PSAd in prediction of long-term ICs was &gt; 0.07 ng/ml2, sensitivity / specificity: 58.3% and 76.1%, respectively. The analysis showed more than 4 times higher odds of developing an infectious complication in PSAd &gt; 0.07 ng/ml2 patients: OR 4.3 (95% CI [1.7 – 10.5], p = 0.001).Conclusion. This study demonstrates data that defines a new clinical non-oncological significance of PSAd as a predictor of the development of long-term infectious complications after TURP.

PI-RADS upgrading as the strongest predictor for the presence of clinically significant prostate cancer in patients with initial PI-RADS-3 lesions

PurposeUnclear lesions on multiparametric magnetic resonance tomography (mpMRI) are challenging for the indication of biopsy in patients with clinical suspicion of prostate cancer (PCa). The aim of this study is the validation of the detection rate of clinically significant PCa (csPCa) in patients with PI-RADS 3 findings and to determine the appropriate follow-up strategy.MethodsIn this retrospective single-center study, patients with maximum PI-RADS 3 lesions underwent targeted MRI/ultrasound-fusion biopsy (tPbx) combined with systematic 12-core biopsy (sPbx) and follow-up mpMRI with further control biopsy. We assessed the evolution of MRI findings (PI-RADS, volume of the lesion), clinical parameters and histopathology in follow-up MRI and biopsies. The primary objective is the detection rate of csPCa, defined as ISUP ≥ 2 findings.ResultsA total of 126 patients (median PSA 6.65 ng/ml; median PSA-density (PSAD) 0.13 ng/ml2) were included. The initial biopsy identified low-risk PCa in 24 cases (19%). During follow-up biopsy, 22.2% of patients showed PI-RADS upgrading (PI-RADS > 3), and 29 patients (23%) exhibited a tumor upgrading. Patients with PI-RADS upgrading had a higher risk of csPCa compared to those without PI-RADS upgrading (42.9% vs. 9.18%, p < 0.05). PI-RADS upgrading was identified as an independent predictor for csPCa in follow-up biopsy (OR 16.20; 95% CI 1.17–224.60; p = 0.038).ConclusionPatients with stable PI-RADS 3 findings may not require a follow-up biopsy. Instead, it is advisable to schedule an MRI, considering that PI-RADS upgrading serves as an independent predictor for csPCa.

Predictors of prostate cancer detection in MRI PI-RADS 3 lesions - Reality of a tertiary center.

The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy, 41 patients would have avoided biopsy (31.5%), but 5 cases of CsPCa would not have been detected (3.4%). We could not identify any statistical significance between other clinical and imagiological variables and CsPCa detection. PI-RADS 3 lesions were associated with a low likelihood of CsPCa detection. A systematic biopsy associated or not with target biopsy is essential in PI-RADS 3 lesions, and targeted biopsy did not demonstrate to be superior in the detection of CsPCa. The presence of abnormal DRE and lesions localized in PZ potentially predict the presence of CsPCa in biopsied PI-RADS 3 lesions.

PI-RADS Version 2.0 Versus Version 2.1: Comparison of Prostate Cancer Gleason Grade Upgrade and Downgrade Rates From MRI-Targeted Biopsy to Radical Prostatectomy.

BACKGROUND. Precise risk stratification through MRI/ultrasound (US) fusion-guided targeted biopsy (TBx) can guide optimal prostate cancer (PCa) management. OBJECTIVE. The purpose of this study was to compare PI-RADS version 2.0 (v2.0) and PI-RADS version 2.1 (v2.1) in terms of the rates of International Society of Urological Pathology (ISUP) grade group (GG) upgrade and downgrade from TBx to radical prostatectomy (RP). METHODS. This study entailed a retrospective post hoc analysis of patients who underwent 3-T prostate MRI at a single institution from May 2015 to March 2023 as part of three prospective clinical trials. Trial participants who underwent MRI followed by MRI/US fusion-guided TBx and RP within a 1-year interval were identified. A single genitourinary radiologist performed clinical interpretations of the MRI examinations using PI-RADS v2.0 from May 2015 to March 2019 and PI-RADS v2.1 from April 2019 to March 2023. Upgrade and downgrade rates from TBx to RP were compared using chi-square tests. Clinically significant cancer was defined as ISUP GG2 or greater. RESULTS. The final analysis included 308 patients (median age, 65 years; median PSA density, 0.16 ng/mL2). The v2.0 group (n = 177) and v2.1 group (n = 131) showed no significant difference in terms of upgrade rate (29% vs 22%, respectively; p = .15), downgrade rate (19% vs 21%, p = .76), clinically significant upgrade rate (14% vs 10%, p = .27), or clinically significant downgrade rate (1% vs 1%, p > .99). The upgrade rate and downgrade rate were also not significantly different between the v2.0 and v2.1 groups when stratifying by index lesion PI-RADS category or index lesion zone, as well as when assessed only in patients without a prior PCa diagnosis (all p > .01). Among patients with GG2 or GG3 at RP (n = 121 for v2.0; n = 103 for v2.1), the concordance rate between TBx and RP was not significantly different between the v2.0 and v2.1 groups (53% vs 57%, p = .51). CONCLUSION. Upgrade and downgrade rates from TBx to RP were not significantly different between patients whose MRI examinations were clinically interpreted using v2.0 or v2.1. CLINICAL IMPACT. Implementation of the most recent PI-RADS update did not improve the incongruence in PCa grade assessment between TBx and surgery.

The Predictive Value of Prostate-Specific Antigen Density: A Retrospective Analysis of Likert 3 Multiparametric MRI of the Prostate.

Background Many international studies have covered the predictors of prostate cancer, but there is limited information pertaining to Likert 3 MRI scores and the diagnosis of clinically significant prostate cancer (cs-PCa). Therefore, this study aimed to assess the detection rate of significant prostate cancer in men with a Likert 3 score multiparametric MRI (mp-MRI) and the predictive value of prostate-specific antigen (PSA) density in detecting significant prostate cancer. Methods This is a retrospective analysis of patients referred for suspected confined prostate cancer. Inclusion criteria were patients with prostate mp-MRIscore of Likert 3 and a prostate biopsy performed. Exclusion criteria included grossly abnormal feeling prostate, no biopsy performed, and an mp-MRI score (Prostate Imaging-Reporting and Data System/Likert) of 1, 2, 4, and 5. cs-PCawas defined as ≥ Gleason 3+4 prostate cancer. PSA density (PSAD) was calculated from MRI estimation of prostate volume. PSAD and histology results were subjected to receiver operating characteristic (ROC) curve analysis with the intention to assess the detection rate of significant prostate cancer in men with Likert 3 mp-MRI and the predictive value of PSAD in detecting significant prostate cancer. Results A total of 819 eligible men had a pre-biopsy mp-MRI scan taken between October 2019 and March 2022. A total of 177 men (21.6%, n = 819) were Likert 3 positive, and 31 did not proceed to take prostate biopsies. A total of 146 patients were included in the study. The median PSAD was 0.19 in men with cs-PCa. Prostate cancer was detected in 42 men (28.8% of the total included set), of which 27 (18.5%) had a Gleason 3+3 prostate cancer and 15 (10.3%) had Gleason ≥ 3+4 prostate cancer. Therefore, 35.7% (n = 42) of biopsy-positive men with Likert 3 mp-MRI had cs-PCa. The ROC curve analysis confirms that PSAD is a predictor of cs-PCa. The optimal PSAD threshold was 0.16 (95% CI: 0.14-0.19), which gives an accuracy of 0.7371, a sensitivity of 0.7333, and a specificity of 0.7375. Conclusion The specificity of PSAD is arguably insufficient for it to stand alone as a decision-making tool when counseling men with equivocal mp-MRI on whether or not to undergo prostate biopsy. A predictive model will need to incorporate other independent risk factors.These may include lesion size, multiplicity, location of lesion(s), and age.

MRI-Based Surrogate Imaging Markers of Aggressiveness in Prostate Cancer: Development of a Machine Learning Model Based on Radiomic Features.

This retrospective study included 86 adult Hispanic men (60 ± 8.2 years, median prostate-specific antigen density (PSA-D) 0.15 ng/mL2) with PCa who underwent prebiopsy 3T MRI followed by targeted MRI-ultrasound fusion and systematic biopsy. Two observers performed 2D segmentation of lesions in T2WI/ADC images. We classified csPCa (GS ≥ 7) vs. non-csPCa (GS = 6). Univariate statistical tests were performed for different parameters, including prostate volume (PV), PSA-D, PI-RADS, and radiomic features. Multivariate models were built using the automatic feature selection algorithm Recursive Feature Elimination (RFE) and different classifiers. A stratified split separated the train/test (80%) and validation (20%) sets. Radiomic features derived from T2WI/ADC are associated with GS in patients with PCa. The best model found was multivariate, including image (T2WI/ADC) and clinical (PV and PSA-D) information. The validation area under the curve (AUC) was 0.80 for differentiating csPCa from non-csPCa, exhibiting better performance than PI-RADS (AUC: 0.71) and PSA-D (AUC: 0.78). Our multivariate ML model outperforms PI-RADS v2.1 and established clinical indicators like PSA-D in classifying csPCa accurately. This underscores MRI-derived radiomics' (T2WI/ADC) potential as a robust biomarker for assessing PCa aggressiveness in Hispanic patients.

The role of tumor density in predicting significant cancer on targeted biopsy of the prostate.

Multiparametric magnetic resonance imaging (mpMRI) is central to diagnosing prostate cancer; however, not all imaged lesions represent clinically significant tumors. We aimed to evaluate the association between the relative tumor volume on mpMRI and clinically significant prostate cancer on biopsy. We retrospectively reviewed the medical records of 340 patients who underwent combined transperineal targeted and systematic prostate biopsies between 2017 and 2021. Tumor volume was estimated based on the mpMRI diameter of suspected lesions. Relative tumor volume (tumor density) was calculated by dividing the tumor and prostate volumes. The study outcome was clinically significant cancer on biopsy. Logistic regression analyses were used to evaluate the association between tumor density and the outcome. The cutoff for tumor density was determined with ROC curves. Median estimated prostate and peripheral zone tumor volumes were 55cm3 and 0.61cm3, respectively. Median PSA density was 0.13 and peripheral zone tumor density was 0.01. Overall, 231 patients (68%) had any cancer and 130 (38%) had clinically significant cancer. On multivariable logistic regression age, PSA, previous biopsy, maximal PI-RADS score, prostate volume, and peripheral zone tumor density were significant predictors of outcome. Using a threshold of 0.006, the sensitivity, specificity, positive and negative predictive values of peripheral zone tumor density were 0.9, 0.51, 0.57, and 0.88, respectively. Peripheral zone tumor density is associated with clinically significant prostate cancer in patients with PI-RADS 4 and 5 mpMRI lesions. Future studies are required to validate our findings and evaluate the role of tumor density in avoiding unnecessary biopsies.

PSA density does not improve predictive accuracy of the UCSF-CAPRA score.

The University of California, San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score is a validated tool using factors at diagnosis to predict prostate cancer outcomes after radical prostatectomy (RP). This study evaluates whether substitution of prostate-specific antigen (PSA) density for serum PSA improves predictive performance of the clinical CAPRA model. Participants were diagnosed in 2000-2019 with stage T1/T2 cancer, underwent RP, with at least a 6-month follow-up. We computed standard CAPRA score using diagnostic age, Gleason grade, percent positive cores, clinical T stage, and serum PSA, and an alternate score using similar variables but substituting PSA density for PSA. We reported CAPRA categories as low (0-2), intermediate (3-5), and high (6-10) risk. Recurrence was defined as two consecutive PSA ≥ 0.2 ng/mL or receipt of salvage treatment. Life table and Kaplan-Meier analysis evaluated recurrence-free survival after prostatectomy. Cox proportional hazards regression models tested associations of standard or alternate CAPRA variables with recurrence risk. Additional models tested associations between standard or alternate CAPRA score with recurrence risk. Cox log-likelihood ratio test (-2 LOG L) assessed model accuracy. A total of 2880 patients had median age 62 years, GG1 30% and GG2 31%, median PSA 6.5, and median PSA density 0.19. Median postoperative follow-up was 45 months. Alternate CAPRA model was associated with shifts in risk scores, with 16% of patients increasing and 7% decreasing (p < 0.01). Recurrence-free survival after RP was 75% at 5 years and 62% at 10 years. Both CAPRA component models were associated with recurrence risk after RP on Cox regression. Covariate fit statistics showed better fit for standard CAPRA model versus alternate (p < 0.01). Standard (hazard ratio [HR]: 1.55; 95% confidence interval [CI]: 1.50-1.61) and alternate (HR: 1.50; 95% CI: 1.44-1.55) CAPRA scores were associated with recurrence risk, with better fit for standard model (p < 0.01). In a 2880 patient cohort followed for median 45 months after RP, alternate CAPRA model using PSA density was associated with higher biochemical recurrence (BCR) risk, but performed inferior to standard CAPRA at predicting BCR. While PSA density is an established prognostic variable in prediagnostic settings and sub-stratifying low-risk disease, it does not improve BCR model predictive accuracy when applied across a range of cancer risk.

Magnetic Resonance Imaging Follow-up of Targeted Biopsy–negative Prostate Lesions

BackgroundThe optimal radiological follow-up of prostate lesions negative on magnetic resonance imaging (MRI)-targeted biopsy (MRI-TB) is yet to be optimised. ObjectiveTo present medium-term radiological and clinical follow-up of biopsy-negative lesions. Design, setting, and participantsThe records for men who underwent multiparametric MRI at the UCLH one-stop clinic for suspected prostate cancer between September 2017 and March 2020 were reviewed (n = 1199). Patients with Likert 4 or 5 lesions were considered (n = 495), and those with a subsequent negative MRI-TB comprised the final study population (n = 91). Outcome measurements and statistical analysisBaseline and follow-up MRI and biopsy data (including prostate-specific antigen [PSA], prostate volume, radiological scores, and presence of any noncancerous pathology) were extracted from reports. The last follow-up date was the date of the last test or review in clinic. Results and limitationsMedian follow-up was 1.8 yr (656 d, interquartile range [IQR] 359–1008). At baseline, the median age was 65.4 yr (IQR 60.7–70.0), median PSA was 7.1 ng/ml (IQR 4.7–10.0), median prostate volume was 54 ml (IQR 39.5–75.0), and median PSA density (PSAD) was 0.13 ng/ml2 (IQR 0.09–0.18). Eighty-six men (95%) had Likert 4 lesions, while the remaining five (5%) had Likert 5 lesions. Only 21 men (23%) had a single lesion; most had at least two. Atrophy was the most prevalent pathology on MRI-TB, present in 64 men (74%), and followed by acute inflammation in 42 (46%), prostatic intraepithelial neoplasia in 33 (36%), chronic inflammation in 18 (20%), atypia in 13 (14%), and granulomatous inflammation in three (3%). Fifty-eight men had a second MRI study (median 376 d, IQR 361–412). At the second MRI, median PSAD decreased to 0.11 ng/ml2 (IQR 0.08–0.18). A Likert 4 or 5 score persisted only in five men (9%); 40 men (69%) were scored Likert 3, while the remaining 13 (22%) were scored Likert 2 (no lesion). Of 45 men with a Likert ≥3 score, most only had one lesion at the second MRI (28 men; 62%). Of six men with repeat MRI-TB during the study period, two were subsequently diagnosed with prostate cancer and both had persistent Likert 4 scores (at baseline and at least one follow-up MRI). ConclusionsMost biopsy-negative MRI lesions in the prostate resolve over time, but any persistent lesions should be closely monitored. Patient summaryLesions in the prostate detected via magnetic resonance imaging (MRI) scans that are negative for cancer on biopsy usually resolve. Repeat MRI can indicate persistent lesions that might need a second biopsy.

MP44-15 THE VALUE OF PROSTATE-SPECIFIC ANTIGEN DENSITY IN LONG-TERM PROSTATE CANCER-MORTALITY RISK PREDICTION

You have accessJournal of UrologyCME1 Apr 2023MP44-15 THE VALUE OF PROSTATE-SPECIFIC ANTIGEN DENSITY IN LONG-TERM PROSTATE CANCER-MORTALITY RISK PREDICTION Sara Yousef Yacoub, Per-Olof Lundgren, Anders Kjellman, and Ove Gustafsson Sara Yousef YacoubSara Yousef Yacoub More articles by this author , Per-Olof LundgrenPer-Olof Lundgren More articles by this author , Anders KjellmanAnders Kjellman More articles by this author , and Ove GustafssonOve Gustafsson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSA density (PSAD) is used to distinguish elevated serum levels of PSA due to benign prostatic hyperplasia (BPH) from high serum levels caused by malignant disease. Several studies have demonstrated an association between high PSAD and risk for both biochemical recurrences after treatment with curative intent, as well as the risk for upstaging after prostatectomy after an initial strategy of active monitoring. In this study, our objective was to examine whether a baseline metric of PSAD is associated with prostate cancer-specific mortality after thirty years of follow-up. METHODS: In the late nineteen eighties, 2400 men between the ages of 55 and 70 were randomly sampled from a background population of about 27 000 men in the same age group living in a defined part of Stockholm, Sweden. 1779 men accepted the invitation for the study. The sampled cohort was invited to undergo screening for prostate cancer with a PSA test, digital rectal exam, and ultrasound of the prostate. PSAD was calculated for each patient. Outcomes, ie prostate cancer-specific mortality were extracted from the Swedish national cause of death registry. Hazard ratios for cancer-specific deaths were estimated using a Cox proportional hazard regression model. The area under the receiver operating curve (AUC) was determined using conditional logistic regression for men with a baseline PSA of 3.0 or more. RESULTS: PSAD was available for 1748 men. Median PSAD was 0.095 ng/mL/cm3 (IQR 0.073-0.14). The age-adjusted hazard ratio for lethal prostate cancer in the cohort of men with PSA>3.0 ng/mL was 3.5 (95% CI 2.5-4.9) per unit increase in PSAD. 463 men had a PSA of 3.0 ng/mL or more; in this cohort, there were 50 deaths attributed to prostate cancer. All 50 men who died from prostate cancer had a PSAD above the median at baseline. A model including PSAD, palpation, and ultrasound findings could distinguish lethal prostate cancer from non-cases at 30 years of follow-up with an AUC of 0.78. CONCLUSIONS: Several risk stratification models or tools have been evaluated to predict high-grade prostate cancer. If the endpoint of high-grade cancer is substituted with cancer-specific mortality a simple measure of PSA density performs similarly. For men with PSA in the gray area, PSAD predicts the lifelong risk for lethal prostate cancer. Limitations to this study include the lack of clinical data during follow-up, e.g not all nonlethal cancers are indolent which should be acknowledged when interpreting the results. Source of Funding: Grafströms foundation for urological research © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e617 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sara Yousef Yacoub More articles by this author Per-Olof Lundgren More articles by this author Anders Kjellman More articles by this author Ove Gustafsson More articles by this author Expand All Advertisement PDF downloadLoading ...

PD39-10 THE ASSOCIATION BETWEEN PSA DENSITY AND THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ACROSS ALL PIRADS SCORES IN MEN WITH POSITIVE MPMRI. WHEN PSA DENSITY CAN HELP AVOIDING PROSTATE BIOPSY?

PD39-10 THE ASSOCIATION BETWEEN PSA DENSITY AND THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER ACROSS ALL PIRADS SCORES IN MEN WITH POSITIVE MPMRI. WHEN PSA DENSITY CAN HELP AVOIDING PROSTATE BIOPSY?

PD39-08 INTER-CENTER VARIABILITY IN POSITIVE PREDICTIVE VALUES OF PIRADS SCORE IN PATIENTS UNDERGOING PROSTATE BIOPSY: RESULTS FROM THE PROMOD STUDY GROUP

PD39-08 INTER-CENTER VARIABILITY IN POSITIVE PREDICTIVE VALUES OF PIRADS SCORE IN PATIENTS UNDERGOING PROSTATE BIOPSY: RESULTS FROM THE PROMOD STUDY GROUP

MP09-08 PREDICTIVE VALUE OF LACDINAC-GLYCOSYLATED PROSTATE SPECIFIC ANTIGEN AT 3 MONTHS AFTER FOCAL THERAPY WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER DURING FOLLOW-UP: A MULTI-INSTITUTIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP09-08 PREDICTIVE VALUE OF LACDINAC-GLYCOSYLATED PROSTATE SPECIFIC ANTIGEN AT 3 MONTHS AFTER FOCAL THERAPY WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER DURING FOLLOW-UP: A MULTI-INSTITUTIONAL STUDY Sunao Shoji, Kazuya Oda, Tatsuo Kano, Tatsuya Umemoto, Mayura Nakano, Masayoshi Kawakami, Masahiro Nitta, Masanori Hasegawa, and Akira Miyajima Sunao ShojiSunao Shoji More articles by this author , Kazuya OdaKazuya Oda More articles by this author , Tatsuo KanoTatsuo Kano More articles by this author , Tatsuya UmemotoTatsuya Umemoto More articles by this author , Mayura NakanoMayura Nakano More articles by this author , Masayoshi KawakamiMasayoshi Kawakami More articles by this author , Masahiro NittaMasahiro Nitta More articles by this author , Masanori HasegawaMasanori Hasegawa More articles by this author , and Akira MiyajimaAkira Miyajima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003224.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: LacdiNAc-glycosylated prostate specific antigen (LDN-PSA) is a PSA carrying a prostate cancer (PC)-associated disaccharide LacdiNAc (GalNAcβ1→4GlcNAc) at the non-reducing terminal of N-glycan. The objective of this study was to evaluate the predictive value of LDN-PSA at 3 months after focal therapy with high-intensity focused ultrasound (HIFU) for the detection of clinically significant prostate cancer (csPC) during follow-up. METHODS: From 2018 to 2019, patients whose serum PSA levels were ≤ 20 ng/ml, and who had undergone focal therapy with HIFU based on magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion image-guided target biopsy and systematic biopsies, were included. LDN-PSA was measured via an automated two-step Wisteria Floribunda Agglutinin lectin–anti-PSA antibody sandwich immunoassay, using an extremely sensitive surface plasmon field-enhanced fluorescence spectrometry system. During follow-up, patients who had elevated PSA values after focal therapy, underwent MRI-TRUS fusion image-guided target and systematic biopsies. The predictive values of LDN-PSA at 3 months after treatment for the prediction of csPC detection in the biopsies were evaluated. RESULTS: Fifty-five patients were included in the study. During median follow-up period of 30 months, 6 patients were diagnosed as pathological recurrences at median 24 months after treatment. Although there were no significant differences in the median PSA and median PSA density (PSAD), there were significant differences in median LDN-PSA (1.69×10-2 U/mL vs. 1.03×10-2 U/mL, p=0.018) and median LDN-PSAD (1.06×10-4 U/mL/cc vs. 0.444×10-4 U/mL/cc, p=0.002) at 3 months after the treatment between the patients with and without detected csPC during follow-up. Using the cut-off value of 0.907×10-4 U/mL/cc of LDN-PSAD, 83% of the patients (n=5) who were diagnosed with pathological recurrence at median 20 months after the treatment, were already predicted to develop this pathological recurrence at 3 months after treatment. CONCLUSIONS: LDN-PSAD at 3 months after focal therapy with HIFU has the potential to predict pathological recurrences during follow-up of these patients. The results could contribute to earlier timing of salvage treatment after focal therapy for csPC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e107 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunao Shoji More articles by this author Kazuya Oda More articles by this author Tatsuo Kano More articles by this author Tatsuya Umemoto More articles by this author Mayura Nakano More articles by this author Masayoshi Kawakami More articles by this author Masahiro Nitta More articles by this author Masanori Hasegawa More articles by this author Akira Miyajima More articles by this author Expand All Advertisement PDF downloadLoading ...

PD39-07 CAN WE STOP DOING SYSTEMATIC BIOPSIES IN MEN WITH PIRADS/LIKERT 5 LESIONS ON MULTI PARAMETRIC MAGNETIC RESONANCE IMAGING? AN ANALYSIS FROM A MULTICENTRE PROSPECTIVE DATASET OF OVER 800 PATIENTS

You have accessJournal of UrologyCME1 Apr 2023PD39-07 CAN WE STOP DOING SYSTEMATIC BIOPSIES IN MEN WITH PIRADS/LIKERT 5 LESIONS ON MULTI PARAMETRIC MAGNETIC RESONANCE IMAGING? AN ANALYSIS FROM A MULTICENTRE PROSPECTIVE DATASET OF OVER 800 PATIENTS Jonathan Aning, Adrian Andreou, Liam Blaney, Paul Burn, Jon Oxley, Sue Mahoney, Sarah-Jane Davies, Lucy Simmons, Neil Trent, Douglas Kopcke, Raj Persad, and Nick Burns-Cox Jonathan AningJonathan Aning More articles by this author , Adrian AndreouAdrian Andreou More articles by this author , Liam BlaneyLiam Blaney More articles by this author , Paul BurnPaul Burn More articles by this author , Jon OxleyJon Oxley More articles by this author , Sue MahoneySue Mahoney More articles by this author , Sarah-Jane DaviesSarah-Jane Davies More articles by this author , Lucy SimmonsLucy Simmons More articles by this author , Neil TrentNeil Trent More articles by this author , Douglas KopckeDouglas Kopcke More articles by this author , Raj PersadRaj Persad More articles by this author , and Nick Burns-CoxNick Burns-Cox More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003342.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-targeted biopsy has been demonstrated to be superior to systematic prostate biopsies in randomised studies. However there are few real-life multicentre prospective data evaluating cognitive targeted local anaesthetic transperineal prostate biopsy (CT-LATPB) outcomes and whether additional value is added by performing systematic biopsies. The South West Prostate Dashboard (SWPD) is largest prospective database of Local Anaesthetic Transperineal Prostate Biopsies in the United Kingdom. We investigated the outcomes of men with PIRADS/LIKERT 5 lesions on mpMRI who underwent CT-LATPB and systematic biopsies in the SWPD. METHODS: Using the SWPD, we identified all men between January 2021 and June 2022 with a PIRADS/LIKERT 5 index lesion on their diagnostic mpMRI at 5 hospitals. We then compared the biopsy outcomes for targeted and systematic prostate biopsies in these men. Data in the SWPD registry is input from hospitals in the region prospectively by trained data inputters. Standardised mpMRI and pathology reporting was implemented prior to commencement of data entry. RESULTS: A total of 3799 men underwent mpMRI prostate in the SWPD over the study period. Of these 808/3799 (21%) men, median age 69, were identified to have a PIRADS/LIKERT 5 lesion and 629/808 (78%) of the men with these lesions were under 75 years. The median PSA density of men with these lesions was over 0.21 in all centres and all men with a PIRADS/LIKERT 5 lesion underwent a prostate biopsy. The median number of prostate cores taken at targeted and systematic biopsy per individual was 15. No evidence of cancer was present in 5% of men biopsied. In the remainder of men the overall International Society of Urological Pathology (ISUP) Grade Group (GG) identified was GG1 (6%), GG2 (33%), GG3 (26%), GG4 (9%), GG5 (21%). Systematic core biopsies identified higher ISUP grade groups than the targeted core biopsies taken in the same men in 78/808 (9%). The upgrading effect would only have changed the clinical management of patients in 17/808 (2%). CONCLUSIONS: Prospective data collection supports the safe diagnosis of clinically significant prostate cancer in men with PIRADS/LIKERT 5 lesions with CT-LATP biopsy only with standardised reporting of mpMRI. Systematic biopsies need only be taken if non clinically significant disease is identified or focal therapy is being considered. This resource efficient patient focused approach is also more environmentally sustainable. Source of Funding: SWAG Cancer Alliance and Peninsula Cancer Alliance © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1047 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Aning More articles by this author Adrian Andreou More articles by this author Liam Blaney More articles by this author Paul Burn More articles by this author Jon Oxley More articles by this author Sue Mahoney More articles by this author Sarah-Jane Davies More articles by this author Lucy Simmons More articles by this author Neil Trent More articles by this author Douglas Kopcke More articles by this author Raj Persad More articles by this author Nick Burns-Cox More articles by this author Expand All Advertisement PDF downloadLoading ...