Ayranci Ali, Caglar Ufuk, Yazili Huseyin Burak, Erdal Feyzi Sinan, Erbin Akif, Sarilar Omer, Ozgor Faruk
Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
Prostate. 2025 Mar;85(4):385-390. doi: 10.1002/pros.24840. Epub 2024 Dec 15.
The use of multiparametric magnetic resonance imaging (MRI) to guide prostate biopsies has improved cancer detection rates, particularly for high-grade tumors. However, despite guidelines recommending biopsies for lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score ≥ 3, the clinical significance of PI-RADS 3 lesions remains uncertain. This uncertainty, coupled with the cost and potential complications of biopsies, underscores the need for more accurate risk stratification strategies to avoid unnecessary procedures. Prostate-specific antigen density (PSAD) and index lesion volume are emerging as potential contributors to improve risk assessment.
This was a retrospective analysis of patients who had undergone an MRI-guided transrectal ultrasound (TRUS) prostate biopsy at a tertiary care institution. Patients with PI-RADS 3 lesions were included, and data on demographics, prostate-specific antigens (PSA), PSAD, lesion diameter, and pathology results were collected. The relationships between PSAD, lesion volume, and pathology outcomes were statistically analyzed.
Of the 213 patients included, 40 were diagnosed with prostate cancer. PSAD and PSAD x lesion diameter were significantly higher in the patients diagnosed with prostate cancer than those with benign lesions. Among the prostate cancer patients, clinically significant prostate cancer (csPCa) had a higher mean PSAD value than clinically insignificant prostate cancer (cisPCa). ROC analysis found PSAD x lesion diameter to have the highest discriminatory power for detecting csPCa.
MRI-guided biopsies offer targeted sampling but the clinical significance of PI-RADS 3 lesions remains uncertain. Index lesion volume and PSAD are promising adjunctive markers for risk assessment. Combining these factors could facilitate the avoidance of unnecessary biopsies and improve the detection of csPCa.
Incorporating PSAD and index lesion volume into biopsy decision-making may enhance risk stratification, particularly for PI-RADS 3 lesions. Further research is needed to validate these findings and enhance the risk assessment strategies used in making decisions regarding prostate biopsy.
使用多参数磁共振成像（MRI）来指导前列腺活检提高了癌症检出率，尤其是对于高级别肿瘤。然而，尽管指南推荐对前列腺影像报告和数据系统（PI-RADS）评分≥3的病变进行活检，但PI-RADS 3类病变的临床意义仍不明确。这种不确定性，再加上活检的成本和潜在并发症，凸显了需要更准确的风险分层策略以避免不必要的检查。前列腺特异性抗原密度（PSAD）和靶病灶体积正逐渐成为改善风险评估的潜在因素。
这是一项对在三级医疗机构接受MRI引导下经直肠超声（TRUS）前列腺活检的患者进行的回顾性分析。纳入PI-RADS 3类病变的患者，并收集人口统计学、前列腺特异性抗原（PSA）、PSAD、病灶直径和病理结果的数据。对PSAD、病灶体积与病理结果之间的关系进行统计学分析。
在纳入的213例患者中，40例被诊断为前列腺癌。诊断为前列腺癌的患者的PSAD及PSAD×病灶直径显著高于良性病变患者。在前列腺癌患者中，临床有意义的前列腺癌（csPCa）的平均PSAD值高于临床无意义的前列腺癌（cisPCa）。ROC分析发现PSAD×病灶直径对检测csPCa具有最高的鉴别力。
MRI引导下的活检提供了靶向取样，但PI-RADS 3类病变的临床意义仍不明确。靶病灶体积和PSAD是有前景的风险评估辅助标志物。结合这些因素可有助于避免不必要的活检并提高csPCa的检出率。
将PSAD和靶病灶体积纳入活检决策可能会增强风险分层，尤其是对于PI-RADS 3类病变。需要进一步研究来验证这些发现并完善用于前列腺活检决策的风险评估策略。
