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PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?

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PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy? / Falkenbach, Fabian; Ambrosini, Francesca; Kachanov, Mykyta; Ortner, Gernot; Maurer, Tobias; Köhler, Daniel; Beyersdorff, Dirk; Graefen, Markus; Budäus, Lars.

In: WORLD J UROL, Vol. 42, No. 1, 20.03.2024, p. 182.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Falkenbach, F, Ambrosini, F, Kachanov, M, Ortner, G, Maurer, T, Köhler, D, Beyersdorff, D, Graefen, M & Budäus, L 2024, 'PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?', WORLD J UROL, vol. 42, no. 1, pp. 182. https://doi.org/10.1007/s00345-024-04894-6

APA

Falkenbach, F., Ambrosini, F., Kachanov, M., Ortner, G., Maurer, T., Köhler, D., Beyersdorff, D., Graefen, M., & Budäus, L. (2024). PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy? WORLD J UROL, 42(1), 182. https://doi.org/10.1007/s00345-024-04894-6

Vancouver

Falkenbach F, Ambrosini F, Kachanov M, Ortner G, Maurer T, Köhler D et al. PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy? WORLD J UROL. 2024 Mar 20;42(1):182. https://doi.org/10.1007/s00345-024-04894-6

Bibtex

@article{e850dcd86bd04427bd22a70ea29376c4,
title = "PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?",
abstract = "OBJECTIVE: In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, {"}PI-RADS 5 patients{"}).MATERIALS AND METHODS: PI-RADS 5 patients who underwent MRI/Ultrasound fusion biopsy (Bx) between 2016 and 2020 were identified in our institutional database. Uni- and multivariable logistic-regression models were used to identify predictors of csPCA-detection (GGG ≥ 2). Risk models were adjusted for ECE, PSA-D, and cT-stage. Corresponding Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were calculated.RESULTS: Among 493 consecutive PI-RADS 5 patients, the median age and PSA was 69 years (IQR 63-74) and 8.9 ng/ml (IQR 6.0-13.7), respectively. CsPCA (GGG ≥ 2) was detected in 405/493 (82%); 36/493 patients (7%) had no cancer. When tabulating for PSA-D of > 0.2 ng/ml/cc and > 0.5 ng/ml/cc, csPCA was found in 228/253 (90%, PI-RADS5 + PSA-D > 0.2 ng/ml/cc) and 54/54 (100%, PI-RADS5 + PSA-D > 0.5 ng/ml/cc). Finally, a model incorporating PSA-D and cT-stage achieved an AUC of 0.79 (CI 0.74-0.83).CONCLUSION: In PI-RADS 5 patients, PSA-D and cT-stage emerged as strong predictors of csPCA at biopsy. Moreover, when adding the threshold of PSA-D > 0,5 ng/ml/cc, all PI-RADS 5 patients were diagnosed with csPCA. Therefore, straight treatment for PCA can be considered, especially if risk-factors for biopsy-related complications such as obligatory dual platelet inhibition are present.",
keywords = "Male, Humans, Prostatic Neoplasms/diagnostic imaging, Prostate-Specific Antigen/analysis, Magnetic Resonance Imaging, Digital Rectal Examination, Retrospective Studies, Biopsy, Image-Guided Biopsy",
author = "Fabian Falkenbach and Francesca Ambrosini and Mykyta Kachanov and Gernot Ortner and Tobias Maurer and Daniel K{\"o}hler and Dirk Beyersdorff and Markus Graefen and Lars Bud{\"a}us",
note = "{\textcopyright} 2024. The Author(s).",
year = "2024",
month = mar,
day = "20",
doi = "10.1007/s00345-024-04894-6",
language = "English",
volume = "42",
pages = "182",
journal = "WORLD J UROL",
issn = "0724-4983",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?

AU - Falkenbach, Fabian

AU - Ambrosini, Francesca

AU - Kachanov, Mykyta

AU - Ortner, Gernot

AU - Maurer, Tobias

AU - Köhler, Daniel

AU - Beyersdorff, Dirk

AU - Graefen, Markus

AU - Budäus, Lars

N1 - © 2024. The Author(s).

PY - 2024/3/20

Y1 - 2024/3/20

N2 - OBJECTIVE: In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, "PI-RADS 5 patients").MATERIALS AND METHODS: PI-RADS 5 patients who underwent MRI/Ultrasound fusion biopsy (Bx) between 2016 and 2020 were identified in our institutional database. Uni- and multivariable logistic-regression models were used to identify predictors of csPCA-detection (GGG ≥ 2). Risk models were adjusted for ECE, PSA-D, and cT-stage. Corresponding Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were calculated.RESULTS: Among 493 consecutive PI-RADS 5 patients, the median age and PSA was 69 years (IQR 63-74) and 8.9 ng/ml (IQR 6.0-13.7), respectively. CsPCA (GGG ≥ 2) was detected in 405/493 (82%); 36/493 patients (7%) had no cancer. When tabulating for PSA-D of > 0.2 ng/ml/cc and > 0.5 ng/ml/cc, csPCA was found in 228/253 (90%, PI-RADS5 + PSA-D > 0.2 ng/ml/cc) and 54/54 (100%, PI-RADS5 + PSA-D > 0.5 ng/ml/cc). Finally, a model incorporating PSA-D and cT-stage achieved an AUC of 0.79 (CI 0.74-0.83).CONCLUSION: In PI-RADS 5 patients, PSA-D and cT-stage emerged as strong predictors of csPCA at biopsy. Moreover, when adding the threshold of PSA-D > 0,5 ng/ml/cc, all PI-RADS 5 patients were diagnosed with csPCA. Therefore, straight treatment for PCA can be considered, especially if risk-factors for biopsy-related complications such as obligatory dual platelet inhibition are present.

AB - OBJECTIVE: In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, "PI-RADS 5 patients").MATERIALS AND METHODS: PI-RADS 5 patients who underwent MRI/Ultrasound fusion biopsy (Bx) between 2016 and 2020 were identified in our institutional database. Uni- and multivariable logistic-regression models were used to identify predictors of csPCA-detection (GGG ≥ 2). Risk models were adjusted for ECE, PSA-D, and cT-stage. Corresponding Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were calculated.RESULTS: Among 493 consecutive PI-RADS 5 patients, the median age and PSA was 69 years (IQR 63-74) and 8.9 ng/ml (IQR 6.0-13.7), respectively. CsPCA (GGG ≥ 2) was detected in 405/493 (82%); 36/493 patients (7%) had no cancer. When tabulating for PSA-D of > 0.2 ng/ml/cc and > 0.5 ng/ml/cc, csPCA was found in 228/253 (90%, PI-RADS5 + PSA-D > 0.2 ng/ml/cc) and 54/54 (100%, PI-RADS5 + PSA-D > 0.5 ng/ml/cc). Finally, a model incorporating PSA-D and cT-stage achieved an AUC of 0.79 (CI 0.74-0.83).CONCLUSION: In PI-RADS 5 patients, PSA-D and cT-stage emerged as strong predictors of csPCA at biopsy. Moreover, when adding the threshold of PSA-D > 0,5 ng/ml/cc, all PI-RADS 5 patients were diagnosed with csPCA. Therefore, straight treatment for PCA can be considered, especially if risk-factors for biopsy-related complications such as obligatory dual platelet inhibition are present.

KW - Male

KW - Humans

KW - Prostatic Neoplasms/diagnostic imaging

KW - Prostate-Specific Antigen/analysis

KW - Magnetic Resonance Imaging

KW - Digital Rectal Examination

KW - Retrospective Studies

KW - Biopsy

KW - Image-Guided Biopsy

U2 - 10.1007/s00345-024-04894-6

DO - 10.1007/s00345-024-04894-6

M3 - SCORING: Journal article

C2 - 38506941

VL - 42

SP - 182

JO - WORLD J UROL

JF - WORLD J UROL

SN - 0724-4983

IS - 1

ER -