Challenges in magnetic resonance imaging-based detection of clinically significant prostate cancer in young patients: two alternative approaches.

BACKGROUND

Addition of magnetic resonance imaging (MRI) in prostate cancer screening remains controversial issue. Despite the increased utilization of MRI, several studies have revealed its potential suboptimal diagnostic efficacy in young patients. This study aimed to further substantiate the limited diagnostic efficiency of MRI positivity [defined as Prostate Imaging Reporting and Data System (PI-RADS) scores ≥3] among young individuals aged ≤55 years suspected of prostate cancer, and more significantly, to evaluate two proposed approaches.

METHODS

A total of 2,599 patients (including 207 young patients) who underwent trans-perineal prostate biopsy between January 2019 and May 2023 were included in this study. Categorical variables were compared using the chi-square or Fisher exact test, while continuous variables were analyzed with the Mann-Whitney test. A multivariate logistic regression model was used to identify independent risk factors for young patients, which was then visualized with a nomogram.

RESULTS

The positive predictive value of MRI positivity in diagnosing clinically significant prostate cancer was significantly lower for young patients than for older patients (33.9% 61.5%). A PI-RADS score ≥4 instead of ≥3 yielded significant improvements in young patients as compared to older patients in terms of specificity (77.5% 48.8%) and positive predictive value (51.4% 33.9%) while providing comparable sensitivity (80.9% 89.4%) and negative predictive value (93.2% 94.0%). Additionally, in this population, multivariable analysis showed that prostate specific antigen density, chief complaint, and PI-RADS score were independent risk factors (P=0.009, P=0.016, and P<0.001, respectively). Receiver operating characteristic curves indicated that incorporating those three parameters yielded the highest area under the curve (0.875). Therefore, this integrated model was used to build a nomogram that could illustrate the probabilities of clinically significant prostate cancer.

CONCLUSIONS

The positive rate of MRI positivity for clinically significant prostate cancer was found to be age dependent, exhibiting a significant decline in younger patients. Among young patients suspected of disease, both adjusting the cutoff value and incorporating a model were effective in minimizing unnecessary biopsies. Further large-scale prospective studies are warranted to validate our findings.