Abstract 342P
Background
Although magnetic resonance imaging (MRI) has been recognized as a triage to recommend prostate biopsy (PB) for prostate cancer (PCa) to minimize unnecessary PB, the routine use of MRI in patients with previous negative prostate biopsy is questionable. The aim was to evaluate the usefulness of prostate-specific antigen (PSA) derivatives, including PSA density (PSAD) and free-to-total PSA ratio (% fPSA) as an indicator for magnetic resonance imaging (MRI) in patients with prior negative PB.
Methods
Among 1189 patients who underwent prostate biopsy (PB) after serum PSA, free PSA test and MRI between October 2015 and June 2024, 251 patients with more than one negative PB previously were enrolled. All patients underwent systematic 12-core PB, and MRI-targeted PB was added for visible lesions on MRI with Prostate Imaging Reporting and Data System Score (PI-RADS) of 3 or more. Gleason score ≥7 was defined as significant PCa.
Results
The optimal cutoff value of PSA, PSAD and % fPSA for predicting PI-RADS ≥ 4 lesions were 11.87 ng/mL, 0.19 ng/mL2 and 18.76%, respectively (all p <0.001). When MRI was only recommended to patients with PSA ≥ 11.87 ng/mL, the use of MRI could be reduced by 45.8%, but 57.6% of significant PCa could be missed. However, when omitting MRI for patients with PSAD <0.19 ng/mL2 and % fPSA >18.76%, in addition to PSA < 11.87 ng/mL, the usage of MRI could be reduced by 22.7% with the risk of missing 9.1% of significant PCa at MRI-targeted PB cores.
Conclusions
When utilizing PSA, PSAD and % fPSA as triage to recommend MRI in patients with prior negative PB, MRI could be reduced by 22.7% with the risk of missing significant PCa of 9.1%.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.