Keywords:
Abdomen, Genital / Reproductive system male, Pelvis, MR, MR-Diffusion/Perfusion, Observer performance, Biopsy, Decision analysis, Cancer, Multidisciplinary cancer care, Pathology
Authors:
A. Labra Weitzler, F. Tapia, C. Silva, J. P. Olivares, A. Zuñiga; Santiago/CL
DOI:
10.26044/ecr2019/C-2160
Conclusion
PSA density is a variable that can help guide management of these cases.
In our population,
a PSA density greater than 0.11 ng/ml/cc had an OR of 4.1 for a clinically significant cancer.
This threshold is lower than the one previously described by the literature (between 0.15 and 0.20 ng/ml/cc).
As a result of our work,
we propose a lower cut-off value for the indication of biopsy in our PI-RADS score 3 patients.
It should be noted that in the period of time studied,
a large proportion of PI-RADS 3 patients from our center were still not biopsied.
Biopsied and non-biopsied groups presented non-significant differences in PSA,
prostate volume and similar PSA density variables.
We can infer that probably the distribution of clinically significant cancer in this non-biopsied group is similar (26,8%) This information was relied to the urology team to adjust their action protocols.
The optimal cutoff value of PSA density to screen for clinically significant prostate cancer in PI-RADS 3 patients is 0.11 ng/ml/cc.
This threshold can be considered as an additional tool to proceed to transrectal biopsy in patients with mpMRI PI-RADS 3 for detection of clinically significant prostate cancer.
These results open the possibility for new applications/studies using this new cutoff point,
proposing a new classification of PI-RADS 3,
being able to incorporate PI-RADS 3A and 3B sub-classes,
according to the values of PSA density.
Fig. 9