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MP19-07 TOWARDS A TAILORED USE OF PSA DENSITY TO DECIDE WHEN TO AVOID PROSTATE BIOPSY IN MEN WITH PIRADS 3 LESIONS ACCORDING TO THE LOCATION OF THE INDEX LESION AT MP-MRI. RESULTS OF A LARGE, MULTI-INSTITUTIONAL SERIES

2024; Lippincott Williams & Wilkins; Volume: 211; Issue: 5S Linguagem: Inglês

10.1097/01.ju.0001008716.22569.77.07

1527-3792

Leonardo Quarta, Armando Stabile, Francesco Barletta, Elio Mazzone, Donato Cannoletta, Francesco Pellegrino, Gabriele Sorce, Antony Pellegrino, Vito Cucchiara, Simone Scuderi, Daniele Robesti, Riccardo Leni, Giorgio Gandaglia, M. Bianchi, Francesco De Cobelli, Giorgio Brembilla, Morgan Rouprêt, R. Jeffrey Karnes, Francesco Montorsi, Alberto Briganti,

Prostate Cancer Diagnosis and Treatment

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP19)1 May 2024MP19-07 TOWARDS A TAILORED USE OF PSA DENSITY TO DECIDE WHEN TO AVOID PROSTATE BIOPSY IN MEN WITH PIRADS 3 LESIONS ACCORDING TO THE LOCATION OF THE INDEX LESION AT MP-MRI. RESULTS OF A LARGE, MULTI-INSTITUTIONAL SERIES Leonardo Quarta, Armando Stabile, Francesco Barletta, Elio Mazzone, Donato Cannoletta, Francesco Pellegrino, Gabriele Sorce, Antony Pellegrino, Vito Cucchiara, Simone Scuderi, Daniele Robesti, Riccardo Leni, Giorgio Gandaglia, Marco Bianchi, Francesco De Cobelli, Giorgio Brembilla, Roupret Morgan, R. Jeffrey Karnes, Francesco Montorsi, and Alberto Briganti Leonardo QuartaLeonardo Quarta , Armando StabileArmando Stabile , Francesco BarlettaFrancesco Barletta , Elio MazzoneElio Mazzone , Donato CannolettaDonato Cannoletta , Francesco PellegrinoFrancesco Pellegrino , Gabriele SorceGabriele Sorce , Antony PellegrinoAntony Pellegrino , Vito CucchiaraVito Cucchiara , Simone ScuderiSimone Scuderi , Daniele RobestiDaniele Robesti , Riccardo LeniRiccardo Leni , Giorgio GandagliaGiorgio Gandaglia , Marco BianchiMarco Bianchi , Francesco De CobelliFrancesco De Cobelli , Giorgio BrembillaGiorgio Brembilla , Roupret MorganRoupret Morgan , R. Jeffrey KarnesR. Jeffrey Karnes , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001008716.22569.77.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Whether to perform biopsy in men with PIRADS 3 lesions at multiparametric magnetic resonance imaging of the prostate (mpMRI) is controversial. The use of PSA density (PSAd) could improve patient selection. However, the role of PSAd according to mpMRI lesion location (peripheral [PZ] vs transitional [TZ]) is unclear. METHODS: We relied on a population of 2,140 patients with positive mpMRI (PIRADS≥3) undergoing systematic plus targeted biopsy (TBx) at three referral centres between 2016 and 2023. PSAd was calculated as ratio of PSA value and prostate volume at mpMRI. We tested the interaction between PSAd and mpMRI lesion location (PZ vs TZ) in predicting csPCa (ISUP≥2) according to PIRADS at multivariable logistic regression analysis (MVA) after accounting for: age, number of target cores and PIRADS (3 vs 4 vs 5). Lowess function explored the relationship between PSAd and the presence of csPCa according to lesion location stratifying by PIRADS. RESULTS: Overall, 877 (41%) patients had csPCa at TBx. Overall, 1648 (77%) vs 492 (23%) patients had mpMRI lesion located in PZ vs TZ. The detection of csPCa in PZ vs TZ lesions was 44 vs 39% (p=0.02). Median PSAd was 0.1 ng/ml/ml for both men with PZ and TZ lesions. PIRADS 3 lesions were more frequent in TZ vs PZ lesions (43 vs 33%, p<0.001). At MVA, the interaction between PSAd and lesion location was associated with csPCa (OR: 0.92; p=0.01). Age (OR: 1.05), PIRADS 4 (OR: 5.1) and 5 (OR: 11) and number of targeted cores (OR: 1.1) were also independent predictors of csPCa (all p<0.001). Figure 1 shows that in patients with PIRADS 3 lesions different PSAd cut off should be used according to the index lesion location, being <0.05 vs <0.13 for PZ vs TZ, with 10 vs 50% potentially avoided biopsies, missing only 7% of csPCa. Conversely, patients with PIRADS≥4 had a risk of csPCa higher than 15% regardless of their PSAd values and lesions location. CONCLUSIONS: PSAd can be used to identify PI-RADS 3 patients that might avoid prostate biopsy. Particularly, men with PI-RADS 3 PZ and TZ lesions should be counselled for avoiding a biopsy in case of PSAd <0.05 and <0.13, respectively. Differently, patients with PI-RADS ≥4 should always be referred for a TBx. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e313 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Leonardo Quarta More articles by this author Armando Stabile More articles by this author Francesco Barletta More articles by this author Elio Mazzone More articles by this author Donato Cannoletta More articles by this author Francesco Pellegrino More articles by this author Gabriele Sorce More articles by this author Antony Pellegrino More articles by this author Vito Cucchiara More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Riccardo Leni More articles by this author Giorgio Gandaglia More articles by this author Marco Bianchi More articles by this author Francesco De Cobelli More articles by this author Giorgio Brembilla More articles by this author Roupret Morgan More articles by this author R. Jeffrey Karnes More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...