KEY TAKEAWAYS
- This study aimed to investigate factors associated with improved cancer detection rates in patients with PI-RADS ≥ 3 lesions.
- The results showed cancer detection rates for PI-RADS ≥ 3 lesions vary by location and prior history.
MRI-fusion prostate biopsy has significantly enhanced the detection of clinically significant prostate cancer (CSC). However, accurately predicting the likelihood of finding CSC before biopsy remains crucial for optimal patient counselling.
Ahmad N Alzubaidi and the team aimed to identify factors that enhance cancer detection rates in patients with PI-RADS ≥ 3 lesions.
Researchers reviewed the pathology of 980 index lesions from 980 patients across 4 medical centers between 2017 and 2020. These patients underwent transrectal multiparametric MRI-targeted prostate biopsies. The lesions were categorized by their PI-RADS scores: 291 were PI-RADS-5, 374 were PI-RADS-4, and 315 were PI-RADS-3.
The study analyzed cancer detection rates for these PI-RADS ≥ 3 lesions, focusing on factors such as lesion location (transitional zone versus peripheral zone), prostate-specific antigen density (PSAD), and history of prior negative conventional transrectal ultrasound-guided biopsies (TRUS).
The mean age, PSA level, prostate volume, and rate of prior negative TRUS biopsy were 66 years (range: 43-90), 7.82 ng/dL (range: 5.6-11.2), 54 cm³ (range: 12-173), and 456 out of 980 cases (46.5%), respectively. Higher PSAD, no prior history of negative TRUS biopsy, and PZ lesions were linked to increased cancer detection rates. Stratified cancer detection rates showed significant differences across subgroups.
The cancer detection rate for a PI-RADS 5 score, PZ lesion with [PSAD ≥ 0.15], and prior negative biopsy was 77%. In contrast, the cancer detection rate for a PI-RADS 4 score, TZ lesion with [PSAD < 0.15], and prior negative biopsy was notably lower at 14%.
The study concluded that for index PI-RADS ≥ 3 lesions, cancer detection rates varied significantly depending on the lesion’s location, prior history of negative TRUS biopsy, and PSAD. These factors are crucial when advising on the potential benefits and expected outcomes of prostate needle biopsy.
Funding was provided by the Penn State Health No Shave November Education and Research Fund.
Source: https://pubmed.ncbi.nlm.nih.gov/39195312/
Alzubaidi AN, Zheng A, Said M, et al. (2024). “Prior Negative Biopsy, PSA Density, and Anatomic Location Impact Cancer Detection Rate of MRI-Targeted PI-RADS Index Lesions.” Curr Oncol. 2024;31(8):4406-4413. Published 2024 Aug 1. doi:10.3390/curroncol31080329
