Related Experiment Video
Updated: Jul 2, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Risk stratification for repeat prostate biopsy: PI-RADS 3 lesions and the differential role of PSA density
Jungkeun Song1, Jungwon Park1, Hyungwoo Ahn2
1Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Purpose:
PI-RADS 3 lesions represent a diagnostic challenge in repeat prostate biopsy. We investigated whether PI-RADS 3 independently predicts negative biopsy outcomes and how PSA density (PSAD) modifies cancer detection across PI-RADS categories.
Materials And Methods:
We retrospectively analyzed 684 patients who underwent repeat MRI-guided prostate biopsy between 2015 and 2022. PI-RADS scores, clinicopathologic variables, biopsy Gleason Scores, and radical prostatectomy findings were assessed. Univariate and multivariate logistic regression identified predictors of positive biopsy. Subgroup analysis examined detection rates stratified by PI-RADS and PSAD.
Results:
Overall, 238 patients (34.8 %) had positive biopsies. PI-RADS 3 was identified in 210 patients (30.7 %) and PI-RADS 4-5 in 274 (40.1 %). Cancer detection differed significantly: 19.0 % for PI-RADS 3 versus 51.8 % for PI-RADS 4-5 (P < 0.001). Multivariate analysis confirmed PI-RADS 3 as an independent predictor of negative biopsy (OR 0.582, 95 % CI 0.364-0.929, P = 0.023), while PI-RADS 4-5 predicted positive biopsy (OR 2.438, P < 0.001). PSAD strongly stratified risk in PI-RADS 4-5 lesions (33.8 % vs 62.4 %, P < 0.001) but showed minimal effect in PI-RADS 3 lesions (16.2 % vs 20.7 %, P = 0.564).
Conclusion:
PI-RADS 3 lesions independently predict negative biopsy in repeat MRI-guided prostate biopsy. PSAD demonstrates differential predictive utility across PI-RADS categories. Risk-stratified management incorporating imaging and clinical biomarkers may optimize decision-making while minimizing unnecessary procedures.
