Avoiding Prostate Biopsies in Patients at Low Risk for Prostate Cancer: A Prospective Evaluation of a...

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Prostate biopsy (PBx) decisions require individual risk assessment.
• The Rotterdam Prostate Cancer Risk Calculator advises low-risk patients to forego PBx.
• Concerns exist regarding the potential for missing clinically significant prostate cancer (csPCa) in this group.

Purpose of the Study:

• To evaluate the safety and efficacy of omitting prostate biopsy (PBx) in low-risk individuals.
• To assess the utility of a PSA-density-based safety net for follow-up.
• To determine if a risk-stratified pathway can prevent missed csPCa.

Main Methods:

• A cohort of 111 patients omitting PBx was followed for a median of 12 months.
• Patients adhered to a PSA-density safety net with specific re-evaluation thresholds.
• Primary, secondary, and tertiary endpoints tracked PSA monitoring, MRI use, and biopsy decisions.

Main Results:

• 97.2% of patients adhered to regular PSA monitoring.
• Only 30% had repeat multiparametric MRI, and 50% underwent biopsy upon risk increase.
• No csPCa was detected, and risk stratification remained largely unchanged (p=0.187).

Conclusions:

• Omitting PBx in a risk-stratified pathway appears safe, potentially negating concerns of missed csPCa.
• A safety net utilizing PSA density and digital rectal examination (DRE) is recommended for follow-up.
• Subsequent PBx is indicated when risk stratification reveals an increased risk during follow-up.