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Certain Risk Factors Could Prevent Unnecessary Biopsy in PI-RADS 3 Lesions

By Leah Lawrence - August 2, 2022

Researchers have identified risk factors associated with clinically significant prostate cancer in men with Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions.

According to a study published in Cancer, most PI-RADS 3 lesions do not contain clinically significant prostate cancer (CSPCa), yet guidelines suggest that these lesions warrant a targeted biopsy. Debate exists whether to complete immediate biopsy or use clinical monitoring.

In this study, the researchers analyzed detection of CSPCa in men who underwent MRI-targeted biopsy for PI-RADS 3 lesions. They reviewed 1,784 men and included 1,537 in the training cohort and 247 in the validation cohort.

Of the included men, 309 (17.3%) had CSPCa. These men were older, had a higher prostate-specific antigen (PSA) density, and a greater likelihood of an anteriorly located lesion than men without CSPCa (P<.01).

The researchers conducted a multivariable analysis and found that PSA density (odds ratio [OR]=1.36; 95% CI, 1.05-1.85; P<.01), age (OR=1.05; 95% CI, 1.02-1.07; P<.01), and a biopsy-naïve status (OR=1.83; 95% CI, 1.38-2.44) were independently associated with CSPCa.

In contrast, a prior negative biopsy was negatively associated with CSPCa.

“What a 12% and 10% model-predicted probabilities of CSPCa being applied as a binary decision making node for pursuing biopsy, 3 of 55 and 1 of 55 true-positive cases of CSPCa would have been selected to forgo biopsy, respectively,” the researchers wrote. “These three missed cases were found to have Gleason GG2 pathology. Additionally, all three were diagnosed on template biopsy with cores targeted to the PI-RADS3 lesion failing to identify CSPCa.”

In contrast, if biopsies had not bene performed, the 12% cutoff points would have prevented 25% of biopsies.

Reference

Multi-institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI-RADS 3 lesions

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