Related Experiment Video
Updated: Jun 4, 2025
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Challenges in magnetic resonance imaging-based detection of clinically significant prostate cancer in young patients:
Tian-Bao Huang1,2,3, Rong-Jie Shi1, Jin-Wei Shang1
1Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Background:
Addition of magnetic resonance imaging (MRI) in prostate cancer screening remains controversial issue. Despite the increased utilization of MRI, several studies have revealed its potential suboptimal diagnostic efficacy in young patients. This study aimed to further substantiate the limited diagnostic efficiency of MRI positivity [defined as Prostate Imaging Reporting and Data System (PI-RADS) scores ≥3] among young individuals aged ≤55 years suspected of prostate cancer, and more significantly, to evaluate two proposed approaches.
Methods:
A total of 2,599 patients (including 207 young patients) who underwent trans-perineal prostate biopsy between January 2019 and May 2023 were included in this study. Categorical variables were compared using the chi-square or Fisher exact test, while continuous variables were analyzed with the Mann-Whitney test. A multivariate logistic regression model was used to identify independent risk factors for young patients, which was then visualized with a nomogram.
Results:
The positive predictive value of MRI positivity in diagnosing clinically significant prostate cancer was significantly lower for young patients than for older patients (33.9% vs. 61.5%). A PI-RADS score ≥4 instead of ≥3 yielded significant improvements in young patients as compared to older patients in terms of specificity (77.5% vs. 48.8%) and positive predictive value (51.4% vs. 33.9%) while providing comparable sensitivity (80.9% vs. 89.4%) and negative predictive value (93.2% vs. 94.0%). Additionally, in this population, multivariable analysis showed that prostate specific antigen density, chief complaint, and PI-RADS score were independent risk factors (P=0.009, P=0.016, and P<0.001, respectively). Receiver operating characteristic curves indicated that incorporating those three parameters yielded the highest area under the curve (0.875). Therefore, this integrated model was used to build a nomogram that could illustrate the probabilities of clinically significant prostate cancer.
Conclusions:
The positive rate of MRI positivity for clinically significant prostate cancer was found to be age dependent, exhibiting a significant decline in younger patients. Among young patients suspected of disease, both adjusting the cutoff value and incorporating a model were effective in minimizing unnecessary biopsies. Further large-scale prospective studies are warranted to validate our findings.
Insights
Magnetic resonance imaging (MRI) has lower accuracy for detecting prostate cancer in younger men. Adjusting the Prostate Imaging Reporting and Data System (PI-RADS) score or using a predictive model improves diagnostic efficiency, reducing unnecessary biopsies.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Prostate cancer screening using magnetic resonance imaging (MRI) is controversial, particularly regarding its efficacy in younger patients.
- Studies indicate potentially suboptimal diagnostic performance of MRI in individuals under 55 years old.
- This research investigates the diagnostic efficiency of MRI positivity (Prostate Imaging Reporting and Data System [PI-RADS] scores ≥3) in young men suspected of prostate cancer.
Purpose of the Study:
- To evaluate the diagnostic efficiency of MRI positivity in young patients (≤55 years) suspected of prostate cancer.
- To assess the impact of adjusting the PI-RADS score cutoff (≥4 vs. ≥3) on diagnostic performance in young vs. older patients.
- To evaluate a proposed integrated model incorporating PI-RADS score, prostate-specific antigen density, and chief complaint for predicting clinically significant prostate cancer in young men.
Main Methods:
- Retrospective analysis of 2,599 patients (207 young) who underwent trans-perineal prostate biopsy.
- Comparison of categorical and continuous variables using chi-square/Fisher exact and Mann-Whitney tests, respectively.
- Multivariate logistic regression and nomogram construction to identify independent risk factors and predict cancer probability.
Main Results:
- MRI positivity had a significantly lower positive predictive value in young patients (33.9%) compared to older patients (61.5%).
- Using a PI-RADS score ≥4 improved specificity and positive predictive value in young patients, with comparable sensitivity and negative predictive value to older patients.
- Prostate-specific antigen density, chief complaint, and PI-RADS score were independent risk factors in young patients; an integrated model achieved an area under the curve of 0.875.
Conclusions:
- The positive rate of MRI for clinically significant prostate cancer is age-dependent, decreasing in younger individuals.
- Adjusting the PI-RADS cutoff and utilizing an integrated predictive model can minimize unnecessary biopsies in young patients.
- Further large-scale prospective studies are needed to validate these findings.
More Related Videos
06:08A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
05:49Use of Magnetic Resonance Imaging and Biopsy Data to Guide Sampling Procedures for Prostate Cancer Biobanking
Published on: October 10, 2019
