Urology practice · 2025
Factors Associated With Early Detection of Clinically Significant Prostate Cancer After a Negative Magnetic Resonance Imaging-Informed Biopsy.
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Jang Jae Woong, Handa Nicole, Alam Ridwan, Li Yutai, Kumar Sai, Slota Jennifer, Huang Mitchell, Schaeffer Edward M, Patel Hiten D, Ross Ashley E
Аннотация
INTRODUCTION: Multiparametric MRI (mpMRI) has improved detection of clinically significant prostate cancer (csPCa). However, negative biopsies still occur, and limited evidence exists to guide follow-up after a negative biopsy. This study aimed to identify clinicopathological factors associated with detection of csPCa within 2 years of an initial negative biopsy informed by mpMRI.
METHODS: We identified patients with a negative biopsy informed by mpMRI who underwent at least 1 repeat biopsy within 2 years. Individuals with prior prostate cancer were excluded. The primary outcome was csPCa, defined as Gleason Grade Group 2 or higher, on repeat biopsy. Baseline and follow-up characteristics were analyzed, and logistic regression models were constructed.
RESULTS: Among 1790 patients with an initial negative biopsy, 176 underwent repeat biopsy and 33 (18.8%) were diagnosed with csPCa. These patients had a higher PSA density, Prostate Imaging Reporting and Data System (PI-RADS) 4 to 5 on baseline MRI, and absence of inflammation on initial biopsy. The model using these features produced an AUC of 0.752. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on baseline biopsy were not associated. Replacing initial imaging findings with persistent PI-RADS 4 or 5 findings on repeat mpMRI modestly improved performance (AUC = 0.780).
CONCLUSIONS: Higher PSA density, PI-RADS 4 to 5 on baseline mpMRI, and absence of inflammation on baseline biopsy were associated with detection of csPCa. Persistent PI-RADS 4 to 5 on repeat mpMRI further increased risk. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation were not associated with csPCa detection.
METHODS: We identified patients with a negative biopsy informed by mpMRI who underwent at least 1 repeat biopsy within 2 years. Individuals with prior prostate cancer were excluded. The primary outcome was csPCa, defined as Gleason Grade Group 2 or higher, on repeat biopsy. Baseline and follow-up characteristics were analyzed, and logistic regression models were constructed.
RESULTS: Among 1790 patients with an initial negative biopsy, 176 underwent repeat biopsy and 33 (18.8%) were diagnosed with csPCa. These patients had a higher PSA density, Prostate Imaging Reporting and Data System (PI-RADS) 4 to 5 on baseline MRI, and absence of inflammation on initial biopsy. The model using these features produced an AUC of 0.752. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on baseline biopsy were not associated. Replacing initial imaging findings with persistent PI-RADS 4 or 5 findings on repeat mpMRI modestly improved performance (AUC = 0.780).
CONCLUSIONS: Higher PSA density, PI-RADS 4 to 5 on baseline mpMRI, and absence of inflammation on baseline biopsy were associated with detection of csPCa. Persistent PI-RADS 4 to 5 on repeat mpMRI further increased risk. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation were not associated with csPCa detection.