@Article{,
AUTHOR = {Noam Bar-Yaakov, Ziv Savin, Ibrahim Fahoum, Sophie Barnes, Yuval Bar-Yosef, Ofer Yossepowitch, Gal Keren-Paz, Roy Mano},
TITLE = {A combined MRI-PSAD risk stratification system for prioritizing prostate biopsies},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {31},
YEAR = {2024},
NUMBER = {1},
PAGES = {11793--11801},
URL = {http://www.techscience.com/CJU/v31n1/59610},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> Prostate cancer screening with PSA
is associated with low specificity; furthermore, little is
known about the optimal timing of biopsy. We aimed to
evaluate whether a risk classification system combining
PSA density (PSAD) and mpMRI can predict clinically
significant cancer and determine biopsy timing.<br/>
<b>Materials and methods:</b> We reviewed the medical
records of 256 men with a PI-RADS ≥ 3 lesion on mpMRI
who underwent transperineal targeted and systematic
biopsies of the prostate between 2017-2019. Patients
were stratified into three risk groups based on PSAD and
mpMRI findings.<br/>
The study endpoint was clinically significant prostate
cancer (CSPC). The association between the risk groups
and CSPC was evaluated.<br/>
<b>Results:</b> Based on the proposed risk stratification system
42/256 men (16%) were high-risk (mpMRI finding of
extra-prostatic extension and/or seminal vesicle invasion and/or a PI-RADS 5 lesion with a PSAD > 0.15 ng/mL2),
164/256 (64%) intermediate-risk (PI-RADS 4-5 lesions
and/or PSAD > 0.15ng/mL2 with no high-risk features)
and 50/256 (20%) low-risk (PI-RADS 3 lesions and PSAD
≤ 0.15 ng/mL2). High-risk patients had significantly higher
rates of CSPC (76%) when compared to intermediate
risk (26%) and low-risk (4%). On multivariable logistic
regression analysis adjusted for age, previous biopsy,
and clinical T-stage we found an association between
intermediate-risk (OR = 4.84, p = 0.038) and high-risk
(OR = 40.13, p < 0.001) features and CSPC. High-risk
patients had a shorter median biopsy delay time (110 days)
compared to intermediate- and low-risk patients (141 and
147 days, respectively). We did not find an association
between biopsy delay and CSPC.<br/>
<b>Conclusions:</b> Our findings suggest that a three-tier risk
classification system based on mpMRI and PSAD can
identify patients at high-risk for CSPC who may benefit
from earlier biopsy.},
DOI = {}
}