Cancer Management and Research (Jul 2021)

Can Prostate-Specific Antigen Density Be an Index to Distinguish Patients Who Can Omit Repeat Prostate Biopsy in Patients with Negative Magnetic Resonance Imaging?

  • Yu J,
  • Boo Y,
  • Kang M,
  • Sung HH,
  • Jeong BC,
  • Seo S,
  • Jeon SS,
  • Lee H,
  • Jeon HG

Journal volume & issue
Vol. Volume 13
pp. 5467 – 5475

Abstract

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Jiwoong Yu, Youngjun Boo, Minyong Kang, Hyun Hwan Sung, Byong Chang Jeong, Seongil Seo, Seong soo Jeon, Hyunmoo Lee, Hwang Gyun Jeon Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaCorrespondence: Hwang Gyun JeonDepartment of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of KoreaTel +82-2-2148-9599Fax +82-2-3410-6992Email [email protected]: We evaluated the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI) in detecting clinically significant prostate cancer (csPCa) according to biopsy setting and prostate-specific antigen density (PSAD) using transperineal template-guided saturation prostate biopsy (TPB) as the reference standard.Methods: A total of 161 patients with biopsy histories and negative pre-biopsy mpMRI (Prostate Imaging Reporting and Data System version 2 scores of less than 3) participated in the study. TPB was performed on the following indications: “prior negative biopsy” in patients with persistent suspicion of prostate cancer (n = 91) or “confirmatory biopsy” in patients who were candidates for active surveillance (n = 70). The csPCa was defined as a Gleason score of 3 + 4 or greater. We calculated the NPV of mpMRI in detecting csPCa according to biopsy history and prostate-specific antigen density (PSAD) and conducted a logistic regression analysis to determine the clinical predicator for the absence of csPCa.Results: The detection rate of csPCa was 5.5% in the prior negative biopsy group and 14.3% in the confirmatory biopsy group (P = 0.057). None of the variables in the logistic regression models including PSAD < 0.15 ng/mL/cc and prior negative biopsy could predict the absence of csPCa. The NPV of mpMRI in detecting csPCa in patients with a prior negative biopsy worsen from 94.5% to 93.3% when combined with PSAD < 0.15 ng/mL/cc.Conclusion: Patients with negative mpMRI findings may not omit repeat biopsy even if their prior biopsy histories are negative and PSADs are < 0.15 ng/mL/cc.Keywords: early detection of cancer, prostatic neoplasm, prostate-specific antigen density, magnetic resonance imaging, negative predictive value, transperineal prostate biopsy

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