Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer?

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Multiparametric MRI (mpMRI) is increasingly used to guide prostate biopsy decisions.
• Identifying men who can safely avoid biopsy is crucial to reduce morbidity and healthcare costs.

Purpose of the Study:

• To determine if a subset of men can avoid prostate biopsy using mpMRI and clinical factors.
• To identify predictors of clinically significant prostate cancer (csPCa) in men with negative mpMRI.

Main Methods:

• Retrospective analysis of 1,149 men undergoing prostate biopsy.
• Evaluation of prebiopsy mpMRI (PI-RADS™ < 3), prostate-specific antigen (PSA) density, and prior biopsy history.
• Multivariable logistic regression to identify predictors of csPCa (Grade Group ≥ 2).

Main Results:

• csPCa detection rate was 18%.
• PSA density < 0.15 ng/ml/cc and prior negative biopsy were independent predictors of absent csPCa.
• The negative predictive value of mpMRI for csPCa improved with lower PSA density, especially in men with prior negative biopsy.

Conclusions:

• Men with negative mpMRI, PSA density < 0.15 ng/ml/cc, and prior negative biopsy may safely avoid rebiopsy.
• Biopsy is recommended for biopsy-naïve men, particularly those with PSA density > 0.15 ng/ml/cc, even with negative mpMRI.