The role of PSA density in decision making to perform transperineal prostate biopsy in men with multi-parametric MRI Likert 2 or 3 scores: A retrospective analysis from a multi-centre Cancer Network study
BAUS ePoster online library. Warren H. 06/21/21; 318993; p1-5
Disclosure(s): None applicable
Ms. Hannah Warren
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Introduction
PSA density (PSAD) can be used when making decisions to avoid prostate biopsies in patients with negative or equivocal mpMRI (Likert1-3), however there is no consensus ideal 'cut-off' value.
Methods
Patients with suspected prostate cancer undergoing mpMRI in a multi-centre UK Cancer Network 2019-2020 were included. 3TMRI scans were reported by experienced uroradiologists. Six-sector systematic, target or combination transperineal prostate biopsies were performed (PrecisionPointTM system). Clinical data were collected retrospectively. Clinically significant disease (CSD) was defined as Gleason≥3+4.
Results
1440 men underwent mpMRI with median age 64 years, median PSA6.7. Prostate mpMRI were reported as Likert 1 in 3%(50/1440), 2 in 36%(524/1440), 3 in 25%(362/1440), 4-5 in 35%(504/1440).
Only 97/524(19%) Likert 2 patients underwent biopsy with overall CSD detected in 19%. CSD was detected in 25% with PSAD>0.12 rising to 33% when PSAD>0.2. If Likert 2 PSAD between 0.12 and 0.2 patients were not biopsied, CSD would have been missed in 7/33(17%).
222/362(62%) Likert 3 patients underwent biopsy with overall CSD in 44%. 196(54%) had a radiological lesion, but this was not associated with CSD (38% no lesion vs 47% lesion; p=0.2). PSAD>0.12 was associated with CSD on biopsy [51% PSAD>0.12 vs 29% PSAD<0.12; p=0.003]. However, CSD was found in 9(30%) of biopsied men with Likert 3, PSA<0.12 and no lesion.
Conclusion
Based on our large multi-center cohort, we recommend considering Likert 2 biopsy when PSAD>0.12 to reduce risk of undetected CSD. Our data does not support PSAD threshold below which omitting biopsy in Likert 3 patients is safe.
PSA density (PSAD) can be used when making decisions to avoid prostate biopsies in patients with negative or equivocal mpMRI (Likert1-3), however there is no consensus ideal 'cut-off' value.
Methods
Patients with suspected prostate cancer undergoing mpMRI in a multi-centre UK Cancer Network 2019-2020 were included. 3TMRI scans were reported by experienced uroradiologists. Six-sector systematic, target or combination transperineal prostate biopsies were performed (PrecisionPointTM system). Clinical data were collected retrospectively. Clinically significant disease (CSD) was defined as Gleason≥3+4.
Results
1440 men underwent mpMRI with median age 64 years, median PSA6.7. Prostate mpMRI were reported as Likert 1 in 3%(50/1440), 2 in 36%(524/1440), 3 in 25%(362/1440), 4-5 in 35%(504/1440).
Only 97/524(19%) Likert 2 patients underwent biopsy with overall CSD detected in 19%. CSD was detected in 25% with PSAD>0.12 rising to 33% when PSAD>0.2. If Likert 2 PSAD between 0.12 and 0.2 patients were not biopsied, CSD would have been missed in 7/33(17%).
222/362(62%) Likert 3 patients underwent biopsy with overall CSD in 44%. 196(54%) had a radiological lesion, but this was not associated with CSD (38% no lesion vs 47% lesion; p=0.2). PSAD>0.12 was associated with CSD on biopsy [51% PSAD>0.12 vs 29% PSAD<0.12; p=0.003]. However, CSD was found in 9(30%) of biopsied men with Likert 3, PSA<0.12 and no lesion.
Conclusion
Based on our large multi-center cohort, we recommend considering Likert 2 biopsy when PSAD>0.12 to reduce risk of undetected CSD. Our data does not support PSAD threshold below which omitting biopsy in Likert 3 patients is safe.
Introduction
PSA density (PSAD) can be used when making decisions to avoid prostate biopsies in patients with negative or equivocal mpMRI (Likert1-3), however there is no consensus ideal 'cut-off' value.
Methods
Patients with suspected prostate cancer undergoing mpMRI in a multi-centre UK Cancer Network 2019-2020 were included. 3TMRI scans were reported by experienced uroradiologists. Six-sector systematic, target or combination transperineal prostate biopsies were performed (PrecisionPointTM system). Clinical data were collected retrospectively. Clinically significant disease (CSD) was defined as Gleason≥3+4.
Results
1440 men underwent mpMRI with median age 64 years, median PSA6.7. Prostate mpMRI were reported as Likert 1 in 3%(50/1440), 2 in 36%(524/1440), 3 in 25%(362/1440), 4-5 in 35%(504/1440).
Only 97/524(19%) Likert 2 patients underwent biopsy with overall CSD detected in 19%. CSD was detected in 25% with PSAD>0.12 rising to 33% when PSAD>0.2. If Likert 2 PSAD between 0.12 and 0.2 patients were not biopsied, CSD would have been missed in 7/33(17%).
222/362(62%) Likert 3 patients underwent biopsy with overall CSD in 44%. 196(54%) had a radiological lesion, but this was not associated with CSD (38% no lesion vs 47% lesion; p=0.2). PSAD>0.12 was associated with CSD on biopsy [51% PSAD>0.12 vs 29% PSAD<0.12; p=0.003]. However, CSD was found in 9(30%) of biopsied men with Likert 3, PSA<0.12 and no lesion.
Conclusion
Based on our large multi-center cohort, we recommend considering Likert 2 biopsy when PSAD>0.12 to reduce risk of undetected CSD. Our data does not support PSAD threshold below which omitting biopsy in Likert 3 patients is safe.
PSA density (PSAD) can be used when making decisions to avoid prostate biopsies in patients with negative or equivocal mpMRI (Likert1-3), however there is no consensus ideal 'cut-off' value.
Methods
Patients with suspected prostate cancer undergoing mpMRI in a multi-centre UK Cancer Network 2019-2020 were included. 3TMRI scans were reported by experienced uroradiologists. Six-sector systematic, target or combination transperineal prostate biopsies were performed (PrecisionPointTM system). Clinical data were collected retrospectively. Clinically significant disease (CSD) was defined as Gleason≥3+4.
Results
1440 men underwent mpMRI with median age 64 years, median PSA6.7. Prostate mpMRI were reported as Likert 1 in 3%(50/1440), 2 in 36%(524/1440), 3 in 25%(362/1440), 4-5 in 35%(504/1440).
Only 97/524(19%) Likert 2 patients underwent biopsy with overall CSD detected in 19%. CSD was detected in 25% with PSAD>0.12 rising to 33% when PSAD>0.2. If Likert 2 PSAD between 0.12 and 0.2 patients were not biopsied, CSD would have been missed in 7/33(17%).
222/362(62%) Likert 3 patients underwent biopsy with overall CSD in 44%. 196(54%) had a radiological lesion, but this was not associated with CSD (38% no lesion vs 47% lesion; p=0.2). PSAD>0.12 was associated with CSD on biopsy [51% PSAD>0.12 vs 29% PSAD<0.12; p=0.003]. However, CSD was found in 9(30%) of biopsied men with Likert 3, PSA<0.12 and no lesion.
Conclusion
Based on our large multi-center cohort, we recommend considering Likert 2 biopsy when PSAD>0.12 to reduce risk of undetected CSD. Our data does not support PSAD threshold below which omitting biopsy in Likert 3 patients is safe.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}