Prevalence of Biopsy-Proven Clinically Significant Prostate Cancer in Patients with PI-RADS 3 on MRI and Factors Associated with It

Farhood  Khaleghimehr; Amirreza  Elahian; Ali  Maadelat; Mazaher  Hadi; Nasrollah  Abian

doi:10.18502/jimc.v8i2.17703

Farhood Khaleghimehr Department of Urology, Hasheminejad kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Amirreza Elahian Department of Urology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Ali Maadelat Faculty of Science, University of Ottawa, Ottawa, Canada
Mazaher Hadi Department of Urology, Hasheminejad kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Nasrollah Abian Department of Urology, 5 Azar Hospital, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran

DOI: https://doi.org/10.18502/jimc.v8i2.17703

Keywords: Biparametric MRI, Clinically significant prostate cancer, PI-RADS, PSA, PSA density

Abstract

Background: To assess prevalence of prostate cancer and clinically significant prostate cancer in patients with PI-RADS 3 on bpMRI and factors associated with them.

Methods: Patients suspicious for prostate cancer following serum Prostate Specific Antigen (PSA) screening, who had PI-RADS 3 on bpMRI, were included. All patients underwent systemic plus MRI targeted biopsy of prostate. Gleason score 3+3 was considered positive for prostate cancer but clinically non-significant one. Higher scores were pertained to as clinically significant prostate cancer. The relationship between patient age, PSA level, PSA density, number of core biopsies, and number of PI-RADS 3 lesions on bpMRI with presence of prostate cancer per se and presence of clinically significant prostate cancer in our patients is assessed.

Results: 244 patients were enrolled. 101 patients had prostate cancer (41.4%). Out of these 101 patients, 34 (13.9% of total) had clinically significant prostate cancer. Among different factors, only PSA density was associated with both prostate cancer (OR=1.05, p=0.001) and clinically significant prostate cancer (OR=1.03, p=0.001). According to receiver operating characteristic curve analysis, best cut off value of PSA density which has highest association with clinically significant prostate cancer in PI-RADS 3 patients would be 0.36; with a sensitivity of 0.38 and specificity of 0.93.

Conclusion: Considering PSA density with threshold of 0.36 for performing biopsy in patients with PI-RADS 3 on bpMRI might lower the rate of unnecessary biopsies.