Does Size Matter? A Retrospective Study Analysing the Size of PI-RADS 4 Lesions and Its Associated Prostate Cancer Positivity with Transperineal Prostate Biopsy.

IF 2 Q2 UROLOGY & NEPHROLOGY
Research and Reports in Urology Pub Date : 2025-02-25 eCollection Date: 2025-01-01 DOI:10.2147/RRU.S499930
Ali Hooshyari, David Scholtz, Keu Maoate, Samuel Robertson, Lodewikus Petrus Vermeulen, Luiz Gustavo Modelli De Andrade, Paulo Roberto Kawano, Peter Gilling, Mark Fraundorfer, Flavio Vasconcelos Ordones
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引用次数: 0

Abstract

Introduction: Magnetic resonance imaging (MRI) is an essential tool in Prostate Cancer (PCa) diagnosis. PI-RADS v2.1 score correlates with clinically significant prostate cancer (CSPCa) and according to the most recent guidelines, prevalence of CSPCa with PI-RADS 4 is 33-41%, while PI-RADS 5 is 62-79%. These groups are separated only by a size of 15 mm yet the difference in risk is significant. This study aims to find a size threshold associated with CSPCa within the PI-RADS 4 group, which may be used in combination with other prostatic parameters, such as PSA density in order to help with risk stratification and patient counselling in the pre-biopsy setting. This may also aid with surveillance of smaller PI-RADS 4 lesions in the setting of a negative biopsy and avoid unnecessary repeat biopsies unless triggered by a size threshold.

Methods: A retrospective study was performed with data from 407 patients undergoing transperineal prostate biopsy (TPPB) between April 2022 and November 2023. A subgroup of patients with PI-RADS 4 was included for analysis. A ROC-AUC was obtained.

Results: Median age was 67 (interquartile range: 61-71) and PSA density 0.20 (interquartile range 0.13-0.28). PI-RADS score correlated with CSPCa: for PI-RADS 1 and 2, the frequency of CSPCa was 10%; for PI-RADS 3, it was 20%; for PI-RADS 4, it was 60%; and for PI-RADS 5, it was 80%, Pearson correlation = 0.51, p < 0.001. The Receiver Operating Characteristic Area Under the Curve (ROC-AUC) was determined to be 0.664 [0.579-0.7499]. The optimal cut-off point was 8.5 mm. Patients with lesions larger than 8.5 mm had 2.31 times higher risk CSPCa.

Conclusion: PI-RADS 4 size does matter and is a useful predictor of CSPCa. In our study, a cut-off of 8.5 mm was identified. The combination of PI-RADS 4 with PSA density provides a specificity higher than 80% for CSPCa detection.

大小重要吗?一项通过经会阴前列腺活检分析 PI-RADS 4 病变大小及其相关前列腺癌阳性率的回顾性研究。
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来源期刊
Research and Reports in Urology
Research and Reports in Urology UROLOGY & NEPHROLOGY-
CiteScore
3.40
自引率
0.00%
发文量
60
审稿时长
16 weeks
期刊介绍: Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.
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