Detection of subsequent clinically significant prostate cancer following initial decision to forgo biopsy in the multiparametric mri era

You have accessJournal of UrologyCME1 Apr 2023MP44-11 DETECTION OF SUBSEQUENT CLINICALLY SIGNIFICANT PROSTATE CANCER FOLLOWING INITIAL DECISION TO FORGO BIOPSY IN THE MULTIPARAMETRIC MRI ERA Eric Li, Anna Busza, Mohammad Siddiqui, Jonathan Aguiar, Parth Shah, Ashorne Mahenthiran, Jasmine Lin, Moataz Soliman, Sai Kumar, Mary Kate Keeter, Clayton Neill, Xinlei Mi, Quan Mai, Edward Schaeffer, Hiten Patel, and Ashley Ross Eric LiEric Li More articles by this author , Anna BuszaAnna Busza More articles by this author , Mohammad SiddiquiMohammad Siddiqui More articles by this author , Jonathan AguiarJonathan Aguiar More articles by this author , Parth ShahParth Shah More articles by this author , Ashorne MahenthiranAshorne Mahenthiran More articles by this author , Jasmine LinJasmine Lin More articles by this author , Moataz SolimanMoataz Soliman More articles by this author , Sai KumarSai Kumar More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , Clayton NeillClayton Neill More articles by this author , Xinlei MiXinlei Mi More articles by this author , Quan MaiQuan Mai More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , Hiten PatelHiten Patel More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Advanced biomarker tests and multiparametric prostate MRI (mpMRI) have improved risk stratification for detection of clinically significant prostate cancer (csPCa, ISUP Grade Group 2+). However, subsequent testing and detection of csPCa among men forgoing initial biopsy has not been well described. Here we characterize the subsequent detection of csPCa in patients who had an initial MRI without biopsy. METHODS: We retrospectively identified biopsy-naïve men presenting with elevated PSA 2-20 ng/mL from March 2018 to June 2021 who received evaluation with mpMRI before biopsy consideration. Initial and follow-up clinicopathologic data including PSA, Prostate Health Index (PHI), mpMRI, and pathology reports were obtained. T-test, Chi-squared, Wilcoxon rank sum test, and multivariable logistic regression were performed. RESULTS: 1494 men underwent mpMRI for initial evaluation, after which 463 (31%) did not pursue biopsy. On multivariable analysis, PSA density (PSAD) <0.1, PHI <55, and PIRADS 1-2 on mpMRI were significant predictors of omitting initial prostate biopsy. Of the men who did not initially receive biopsy, 353 men had minimum 6 months follow-up with median follow-up of 1.8 years. 15% (53/353) underwent repeat mpMRI. Overall, 2% of men (n=7) who originally omitted biopsy with follow-up were subsequently diagnosed with csPCa, six on subsequent prostate biopsy and one with incidental csPCa after holmium enucleation of the prostate (HoLEP). All patients diagnosed with csPCa had PIRADS 4 or 5 on repeat MRI. CONCLUSIONS: The subsequent detection rate of csPCa among patients not initially biopsied after mpMRI is low at 2%. Of the patients followed by serum biomarkers (i.e. PSA) with for cause MRIs, only the patients who developed PIRADS 4 or 5 lesions were found to have csPCa. Our institutional experience suggests that decisions to omit biopsy after MRI are often safe; additionally, if there is clinical suspicion leading to a repeat MRI, biopsy can again be omitted for mpMRIs scored as PIRADS 1-3. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e615 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Li More articles by this author Anna Busza More articles by this author Mohammad Siddiqui More articles by this author Jonathan Aguiar More articles by this author Parth Shah More articles by this author Ashorne Mahenthiran More articles by this author Jasmine Lin More articles by this author Moataz Soliman More articles by this author Sai Kumar More articles by this author Mary Kate Keeter More articles by this author Clayton Neill More articles by this author Xinlei Mi More articles by this author Quan Mai More articles by this author Edward Schaeffer More articles by this author Hiten Patel More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF downloadLoading ...