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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.

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
|January 25, 2024
PubMed
Abstract

Insights

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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