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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
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Risk of Clinically Significant Prostate Cancer after a Nonsuspicious Prostate MRI-A Comparison with the General
Juho Pylväläinen1,2, Jaakko Hoffström2, Anu Kenttämies1
1Department of Radiology, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland.
Summary
Men with non-suspicious prostate MRI (nMRI) have a higher risk of clinically significant prostate cancer (csPCa). However, low PSA density (PSAD) in these men may indicate a lower risk, warranting careful consideration for biopsies.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Prostate cancer risk stratification is crucial for appropriate patient management.
- Nonsuspicious prostate MRI (nMRI) findings (PI-RADS ≤ 2) require further evaluation to differentiate clinically significant prostate cancer (csPCa) from insignificant prostate cancer (isPCa).
- The role of PSA density (PSAD) in risk stratification for men with nMRI is under investigation.
Purpose of the Study:
- To compare the risk of csPCa and isPCa in men with nMRI versus the general population.
- To assess the utility of PSAD in stratifying risk among men with nMRI.
Main Methods:
- Retrospective population-based cohort study of 1,682 men aged 50-79 who underwent nMRI.
- Comparison of age-standardized incidence rates (IR) and odds ratios (OR) of csPCa and isPCa with a matched general population (n=230,458) over six years.
- Subgroup analysis for 920 men with nMRI and PSAD < 0.15 ng/mL/cm³.
Main Results:
- Men with nMRI showed a significantly higher IR of csPCa compared to the general population (IRR 3.4).
- The IR of csPCa was substantially lower in men with nMRI and low PSAD (IRR 1.4).
- Men with nMRI had higher odds of isPCa (OR 2.4), which increased significantly with low PSAD (OR 5.0).
Conclusions:
- The risk of csPCa is not negligible in men with nMRI.
- Low PSAD (< 0.15 ng/mL/cm³) in men with nMRI indicates a potentially worse harm-benefit balance, suggesting careful consideration for biopsies.
- Prostate biopsies for men with nMRI should be reserved for cases identified by additional risk stratification.
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