A combined MRI-PSAD risk stratification system for prioritizing prostate biopsies

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Prostate-specific antigen (PSA) screening has low specificity.
• Optimal biopsy timing for prostate cancer remains unclear.
• Combining PSA density (PSAD) and multiparametric MRI (mpMRI) may improve risk stratification.

Purpose of the Study:

• To evaluate a risk classification system using PSAD and mpMRI.
• To predict clinically significant prostate cancer (CSPC).
• To determine optimal biopsy timing.

Main Methods:

• Retrospective review of 256 men with PI-RADS ≥ 3 on mpMRI.
• Stratification into high, intermediate, and low-risk groups based on PSAD and mpMRI findings.
• Evaluation of the association between risk groups and CSPC.

Main Results:

• High-risk patients (16%) had a 76% CSPC rate, intermediate-risk (64%) had 26%, and low-risk (20%) had 4%.
• Multivariable analysis showed high-risk (OR=40.13) and intermediate-risk (OR=4.84) features were associated with CSPC.
• High-risk patients had shorter biopsy delays, but delay time did not correlate with CSPC.

Conclusions:

• A three-tier risk classification using mpMRI and PSAD effectively identifies patients at high risk for CSPC.
• This system may guide earlier biopsy decisions for high-risk individuals.
• Further research can refine biopsy timing strategies based on risk stratification.