A comprehensive prostate biopsy standardization system according to quantitative multiparametric MRI and PSA value:...

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Current guidelines often recommend simultaneous systematic biopsy (SB) and targeted biopsy (TB) for suspected prostate cancer.
• However, this study explores the potential for targeted biopsy (TB) alone in patients with high-risk Prostate Imaging-Reporting and Data System (PI-RADS) scores (4/5).

Purpose of the Study:

• To develop and validate a predictive model for identifying prostate cancer in PI-RADS 4/5 lesions.
• To assess if targeted biopsy (TB) alone is sufficient for these patients, potentially reducing the need for systematic biopsy (SB).

Main Methods:

• Retrospective analysis of transperineal prostate biopsy data from patients with PI-RADS 4 and 5 scores.
• Development of a prediction model using a training set (2019-2020) and validation using a separate set (2021).
• Stepwise logistic regression analysis was employed to identify significant clinical factors (age, lesion count, histological region, PI-RADS score, PSA density) for the model.

Main Results:

• The P.R.O.S.T score, incorporating age, lesion count, histological region, PI-RADS score, and PSA density, demonstrated significant correlation with TB results.
• The prediction model achieved an Area Under the Curve (AUC) of 0.840 in the training set and 0.816 in the validation set, indicating good predictive efficiency.
• Optimal threshold yielded a specificity of 0.765 and sensitivity of 0.752.

Conclusions:

• The P.R.O.S.T score effectively screens PI-RADS 4/5 lesions in prostate cancer diagnosis.
• This scoring system may assist physicians in selecting patients who require prostate biopsy, thereby reducing unnecessary systematic biopsies.