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Published on: April 9, 2019
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Using IsoPSA With Prostate Imaging Reporting and Data System Score May Help Refine Biopsy Decision Making in Patients
Tarik Benidir1, Zaeem Lone2, Andrew Wood1
1Department of Urology, Glickman Urological and Kidney Institute, Cleveland, OH.
Urology
|March 25, 2023
Summary
IsoPSA, a novel serum assay, combined with PI-RADS imaging, improves detection of clinically significant prostate cancer (csPCa). This combination helps refine biopsy decisions, potentially reducing unnecessary procedures for patients with low-risk results.
Area of Science:
- Urology
- Oncology
- Biomarker Discovery
Background:
- Prostate cancer diagnosis relies on PSA testing and MRI, but biopsy decisions can be challenging.
- Clinically significant prostate cancer (csPCa) detection requires accurate risk stratification.
- IsoPSA is a validated structure-based serum assay for csPCa detection.
Purpose of the Study:
- To evaluate the utility of IsoPSA in conjunction with PI-RADS for improving prostate biopsy decision-making.
- To assess if combining IsoPSA with PI-RADS can enhance the detection of csPCa.
- To determine if this combined approach can help identify patients who may safely avoid biopsy.
Main Methods:
- Retrospective review of prospectively collected data from 207 patients with elevated PSA (>4.0 ng/mL).
- Patients underwent IsoPSA testing and prostate MRI within one year, followed by biopsy.
- Multivariable logistic regression and predictive probability modeling were used to analyze IsoPSA and PI-RADS scores for csPCa prediction.
Main Results:
- Elevated IsoPSA ratio (≥6.0) and PI-RADS 4-5 were significant predictors of csPCa (OR: 5.06, P=0.015 and OR: 6.37, P<.001, respectively).
- The combination of elevated IsoPSA and PI-RADS 4-5 demonstrated the highest predictive accuracy (AUC: 0.83, P<.001).
- A low IsoPSA ratio (≤6) with PI-RADS 1-3 resulted in a <5% predicted probability of csPCa.
Conclusions:
- Combining PI-RADS with IsoPSA ratios refines prostate biopsy decision-making.
- In patients with negative/equivocal MRI (PI-RADS 1-3) and low IsoPSA, the predicted probability of csPCa is sufficiently low to consider omitting biopsy.
