Significant Prostate Cancer in Patients with PI-RADS Category 3 Lesions: A Single-Center, Retrospective Cohort Study
Urology Journal,
Vol. 20 No. 05 (2023),
23 October 2023
,
Page 329-336
https://doi.org/10.22037/uj.v20i.7610
Abstract
Purpose: The Prostate Imaging-Reporting and Data System (PI-RADS) category 3 is the most ambiguous lesion with a variable clinically significant prostate cancer (CsPCa) detection rate. Prostate-specific antigen density (PSAD) has been investigated as an adjunctive factor to improve the diagnostic efficiency of PI-RADS categories. This study aimed to investigate the utility of PSAD as an adjunctive factor in predicting CsPCA risk in patients with PI-RADS 3 lesions.
Materials and Methods: The patients with an initial PI-RADS 3 category lesion (n=142) scheduled for systematic and magnetic resonance imaging-guided prostate biopsy between 2018 and 2022 were retrospectively evaluated. Demographic and clinical variables, including PSAD, were collected. The rate of CsPCa was the primary outcome. The impact of PSAD on the CsPCa detection rate was the secondary outcome.
Results: The median age was 62 years. The rate of CsPCa was 8.5% (n=12). The patients with CsPCa have significantly lower prostate volüme and higher PSAD levels than those without CsPCa (p=0.016 and p=0.012). The cut-off values of PSAD in predicting CsPCa in all PI-RADS 3 patients and patients with CsPCa and clinically insignificant prostate cancer (n=26) were ≥0.181 ng/ml2. The sensitivity and specificity values for PSAD ≥0.181 ng/ml2 were of 75% (95% CI: 42.8%-94.5%) and 81.5% (95% CI: 73.4%-88.0%) in predicting CsPCa among PI-RADS 3 category.
Conclusion: PSAD values higher than 0.181 ng/ml2 can be used as an adjunctive clinical parameter in predicting CsPCa in patients with PI-RADS 3 lesions and differentiating CsPCa from clinically insignificant prostate cancer cases.
- prostate cancer
- multiparametric prostate MRI
- PI-RADS score
- PSAD
- sensitivity
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References
Boschheidgen M, Schimmöller L, Doerfler S, et al. Single center analysis of an advisable control interval for follow-up of patients with PI-RADS category 3 in multiparametric MRI of the prostate. Sci Rep. 2022 25;12(1):6746
Li T, Sun L, Li Q, et al. Development and Validation of a Radiomics Nomogram for Predicting Clinically Significant Prostate Cancer in PI-RADS 3 Lesions. Front Oncol. 2022 26;11:825429.
Natale C, Koller CR, Greenberg JW, Pincus J, Krane LS. Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions. Life (Basel). 2021 19;11(12):1432..
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.acr.org/-/media/ACR/Files/RADS/Pi-RADS/PIRADS-V2-1.pdf
Jin P, Yang L, Qiao X, et al. Utility of Clinical-Radiomic Model to Identify Clinically Significant Prostate Cancer in Biparametric MRI PI-RADS V2.1 Category 3 Lesions. Front Oncol. 2022 24;12:840786.
Rico L, Blas L, Vitagliano G, Contreras P, Rios Pita H, Ameri C. PI-RADS 3 lesions: Does the association of the lesion volume with the prostate-specific antigen density matter in the diagnosis of clinically significant prostate cancer? Urol Oncol. 2021;39(7):431.e9-431.e13
Alanee S, Deebajah M, Dabaja A, Peabody J, Menon M. Utilizing lesion diameter and prostate specific antigen density to decide on magnetic resonance imaging guided confirmatory biopsy of prostate imaging reporting and data system score three lesions in African American prostate cancer patients managed with active surveillance. Int Urol Nephrol. 2022;54(4):799-803.
Merat S, Blümlein T, Klarhöfer M, et al. Impact of Chronic Prostatitis on the PI-RADS Score 3: Proposal for the Addition of a Novel Binary Suffix. Diagnostics (Basel). 2021 30;11(4):623
Morote J, Campistol M, Triquell M, et al. Improving the Early Detection of Clinically Significant Prostate Cancer in Men in the Challenging Prostate Imaging-Reporting and Data System 3 Category. Eur Urol Open Sci. 2022 23;37:38-44.
Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017;71(4):618-629.
Sathianathen NJ, Omer A, Harriss E, et al. Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis. Eur Urol. 2020;78(3):402-414.
Mazzone E, Gandaglia G, Ploussard G, et al. Risk Stratification of Patients Candidate to Radical Prostatectomy Based on Clinical and Multiparametric Magnetic Resonance Imaging Parameters: Development and External Validation of Novel Risk Groups. Eur Urol. 2022;81(2):193-203.
Schoots IG. MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions? Transl Androl Urol. 2018;7(1):70-82.
Rahota RG, Diamand R, Malavaud B, et al. Pathological features of Prostate Imaging Reporting and Data System (PI-RADS) 3 MRI lesions in biopsy and radical prostatectomy specimens. BJU Int. 2022;129(5):621-626.
Tosoian JJ, Singhal U, Davenport MS, et al. Urinary MyProstateScore (MPS) to Rule out Clinically-Significant Cancer in Men with Equivocal (PI-RADS 3) Multiparametric MRI: Addressing an Unmet Clinical Need. Urology. 2021 11:S0090-4295(21)01162-6.
Hauth E, Jaeger H, Hohmuth H, Beer M. Follow-up MR imaging of PI-RADS 3 and PI-RADS 4 prostate lesions. Clin Imaging. 2017;43:64-68.
Versalle D, Qi J, Noyes SL, et al. Michigan Urological Surgery Improvement Collaborative. Practice-Level Variation in the Decision to Biopsy Prostate Imaging-Reporting and Data System 3 Lesions in Favorable-Risk Prostate Cancer Patients. Urology. 2022 23:S0090-4295(22)00070-X.
Aslam S, Tsang J, Bickle I, Saiepour A. Multiparametric MRI prostate PI-RAD scoring in a district general hospital: correlating PI-RADS 3 results with histological findings. Br J Radiol. 2022 1;95(1131):20210804.
Hectors SJ, Chen C, Chen J, et al.. Magnetic Resonance Imaging Radiomics-Based Machine Learning Prediction of Clinically Significant Prostate Cancer in Equivocal PI-RADS 3 Lesions. J Magn Reson Imaging. 2021;54(5):1466-1473.
Gomez-Gomez E, Moreno Sorribas S, Valero-Rosa J, et al. Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy? Diagnostics (Basel). 2021 26;11(8):1335.
Lim CS, Abreu-Gomez J, Thornhill R, et al. Utility of machine learning of apparent diffusion coefficient (ADC) and T2-weighted (T2W) radiomic features in PI-RADS version 2.1 category 3 lesions to predict prostate cancer diagnosis. Abdom Radiol (NY). 2021;46(12):5647-5658.
Akdas A, Tarcan T, Türkeri L, Cevik I, Biren T, Ilker Y. The impact of prostate-specific antigen density in predicting prostate cancer when serum prostate-specific antigen levels are less than 10 ng/ml. Eur Urol. 1996;29(2):189-92.
Huang C, Qiu F, Jin D, et al. New Diagnostic Model for Clinically Significant Prostate Cancer in Biopsy-Naïve Men With PIRADS 3. Front Oncol. 2022 4;12:908956.
Wang Z, Chan MT, Tsang WC, Chiong E. Utility of serum biomarkers for predicting cancer in patients with previous negative prostate biopsy. World J Urol. 2022;40(9):2255-2260
Kim YJ, Huh JS, Park KK. Effectiveness of Bi-Parametric MR/US Fusion Biopsy for Detecting Clinically Significant Prostate Cancer in Prostate Biopsy Naïve Men. Yonsei Med J. 2019;60(4):346-351.
John S, Cooper S, Breau RH,et al. Multiparametric magnetic resonance imaging - Transrectal ultrasound-guided cognitive fusion biopsy of the prostate: Clinically significant cancer detection rates stratified by the Prostate Imaging and Data Reporting System version 2 assessment category. Can Urol Assoc J. 2018 19;12(12):401–6.
Deniffel D, Healy GM, Dong X, et al. Avoiding Unnecessary Biopsy: MRI-based Risk Models versus a PI-RADS and PSA Density Strategy for Clinically Significant Prostate Cancer. Radiology. 2021;300(2):369-379.
Westphalen AC, Fazel F, Nguyen H, et al. Detection of clinically signifi cant prostate cancer with PIRADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions. Int Braz J Urol. 2019;45(4):713-723.
Pepe P, Garufi A, Priolo GD, Galia A, Fraggetta F, Pennisi M. Is it Time to Perform Only Magnetic Resonance Imaging Targeted Cores? Our Experience with 1,032 Men Who Underwent Prostate Biopsy. J Urol. 2018;200(4):774-778.
Pepe P, Candiano G, Pepe L, Pennisi M, Fraggetta F. mpMRI PI-RADS score 3 lesions diagnosed by reference vs affiliated radiological centers: Our experience in 950 cases. Arch Ital Urol Androl. 2021 28;93(2):139-142.
Roscigno M, Stabile A, Lughezzani G, et al. The Use of Multiparametric Magnetic Resonance Imaging for Follow-up of Patients Included in Active Surveillance Protocol. Can PSA Density Discriminate Patients at Different Risk of Reclassification? Clin Genitourin Cancer. 2020;18(6):e698-e704.
Distler FA, Radtke JP, Bonekamp D, et al. The Value of PSA Density in Combination with PI-RADS™ for the Accuracy of Prostate Cancer Prediction. J Urol. 2017;198(3):575-582.
Rodríguez Cabello MA, Méndez Rubio S, Platas Sancho A, Carballido Rodríguez J. Diagnostic evaluation and incorporation of PSA density and the prostate imaging and data reporting system (PIRADS) version 2 classification in risk-nomograms for prostate cancer. World J Urol. 2022; 40(10):2439-2450
Frisbie JW, Van Besien AJ, Lee A, et al. PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer. Prostate Cancer Prostatic Dis. 2022 6.
Schoots IG, Osses DF, Drost FH, et al. Reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSA-density, with different thresholds for significant disease. Transl Androl Urol. 2018;7(1):132-144.
Wang ZB, Wei CG, Zhang YY, et al. The Role of PSA Density among PI-RADS v2.1 Categories to Avoid an Unnecessary Transition Zone Biopsy in Patients with PSA 4-20 ng/mL. Biomed Res Int. 2021 11;2021:3995789.
Wang C, Wang YY, Wang SY, et al. Peripheral zone PSA density: a predominant variable to improve prostate cancer detection efficiency in men with PSA higher than 4 ng ml-1. Asian J Androl. 2021;23(4):415-420.
Ryoo H, Kang MY, Sung HH, et al. Detection of prostate cancer using prostate imaging reporting and data system score and prostate-specific antigen density in biopsy-naive and prior biopsy-negative patients. Prostate Int. 2020;8(3):125-129.
Washington SL 3rd, Baskin AS, Ameli N, et al. MRI-Based Prostate-Specific Antigen Density Predicts Gleason Score Upgrade in an Active Surveillance Cohort. AJR Am J Roentgenol. 2020;214(3):574-578.
Roscigno M, Stabile A, Lughezzani G, et al. Multiparametric magnetic resonance imaging and clinical variables: Which is the best combination to predict reclassification in active surveillance patients? Prostate Int. 2020;8(4):167-172.
Venderink W, van Luijtelaar A, Bomers JGR, et al. Results of Targeted Biopsy in Men with Magnetic Resonance Imaging Lesions Classified Equivocal, Likely or Highly Likely to Be Clinically Significant Prostate Cancer. Eur Urol. 2018;73(3):353-360.
Pepe P, Pepe L, Cosentino S, Ippolito M, Pennisi M, Fraggetta F. Detection Rate of 68Ga-PSMA PET/CT vs. mpMRI Targeted Biopsy for Clinically Significant Prostate Cancer. Anticancer Res. 2022;42(6):3011-3015.
Pepe P, Pepe L, Tamburo M, Marletta G, Pennisi M, Fraggetta F. Targeted prostate biopsy: 68Ga-PSMA PET/CT vs. mpMRI in the diagnosis of prostate cancer. Arch Ital Urol Androl. 2022 26;94(3):274-277.
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