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Detection of clinically significant prostate cancer following initial omission of biopsy in multiparametric MRI era

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  • Clinical Research
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Prostate Cancer and Prostatic Diseases Submit manuscript

Abstract

Background

Multiparametric prostate MRI (mpMRI) is being increasingly adopted for work-up of prostate cancer. For patients selected to omit biopsy, we identified factors associated with repeat MRI, eventual prostate biopsy, and subsequent detection of clinically significant prostate cancer (csPCa, Grade Group ≥2).

Methods

We identified biopsy-naïve men presenting with PSA 2−20 ng/mL (March 2018−June 2021) undergoing initial mpMRI with PIRADS 1–3 lesions who were not selected for biopsy with ≥6 months follow-up. We examined factors associated with repeat mpMRI, progression to biopsy, and subsequent detection of csPCa with univariable and multivariable logistic regression.

Results

Of 1494 men, 31% (463/1494) did not pursue biopsy. PSA density (PSAD) ≤ 0.1, prostate health index (PHI) < 55, and PIRADS 1−2 were associated with omission of prostate biopsy. csPCa diagnosis-free survival was 97.6% (326/334) with median follow up of 23.1 months (IQR 15.1−34.6 months). Black race, PSA, PHI, PSA density, and PSA and PHI velocity were significant predictors of undergoing repeat mpMRI (15.6%, 52/334) and subsequent biopsy (8.4%, 28/334). 8 men were subsequently diagnosed with csPCa (N = 7 on prostate biopsy; N = 1 incidentally on holmium enucleation of prostate). All patients diagnosed with csPCa had PIRADS 4−5 on repeat mpMRI.

Conclusions

The subsequent detection rate of csPCa among patients not initially biopsied after mpMRI was low at 2.4%. Decisions to omit biopsy after initial reassuring PHI, PSAD, and mpMRI appear safe with subsequent reassuring serum biomarkers and for cause mpMRI during follow-up.

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Fig. 1: Flowchart of study design.
Fig. 2: PSA and PHI velocity by subsequent biopsy status and repeat mpMRI.

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Data availability

Data are available for bona fide researchers who request it from the authors.

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Author notes

  1. These authors contributed equally: Hiten D. Patel, Ashley E. Ross.

Authors and Affiliations

  1. Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA

    Eric V. Li, Anna M. Busza, Mohammad R. Siddiqui, Jonathan A. Aguiar, Mary-Kate Keeter, Clayton Neill, Edward M. Schaeffer, Hiten D. Patel & Ashley E. Ross

  2. Department of Preventive Medicine-Division of Biostatistics, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA

    Sai K. Kumar & **nlei Mi

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  1. Eric V. Li
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Contributions

Conceptualization: EVL, EMS, HDP, AER. Methodology: EVL, SKK. Software/Validation: SKK. Formal analysis: EVL, SKK. Investigation: EVL, AMB, MRS, JAA, CN, SKK, XM. Resources: CN, SKK. Data Curation: EVL, AMB, MRS, JAA. Writing – Original Draft: EVL, AMB, JAA. Writing- Review & Editing: EVL, AMB, MRS, JAA, MKK, CN, SKK, XM, EMS, HDP, AER. Visualization: EVL, SKK. Supervision: EMS, HDP, AER. Project administration: MKK. Funding acquisition: HDP, AER.

Corresponding author

Correspondence to Eric V. Li.

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Competing interests

AER is engaged in consulting with American Society of Clinical Oncology (ASCO), Astellas, Bayer HealthCare Pharmaceuticals, Blue Earth Diagnostics, Janssen Biotech, Lantheus Medical Imaging, Myovant Sciences, NCCN, Pfizer, Tempus Health, and Veracyte. EMS is engaged in consulting with Astellas, Lantheus Medical Imaging, Pfizer. • The other contributing authors have no conflicts of interest to declare.

Ethics approval and consent to participate

The study was reviewed under IRB STU00211144 issued by Northwestern University. The study was performed in accordance with the Declaration of Helsinki.

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Li, E.V., Busza, A.M., Siddiqui, M.R. et al. Detection of clinically significant prostate cancer following initial omission of biopsy in multiparametric MRI era. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00853-9

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