Prostate-specific antigen density cutoff of 0.15 ng/ml/cc to propose prostate biopsies to patients with negative magnetic resonance imaging: Efficient threshold or legacy of the past? Journal Article
| Authors: | Pellegrino, F.; Tin, A. L.; Martini, A.; Vertosick, E. A.; Porwal, S. P.; Stabile, A.; Gandaglia, G.; Eastham, J. A.; Briganti, A.; Montorsi, F.; Vickers, A. J. |
| Article Title: | Prostate-specific antigen density cutoff of 0.15 ng/ml/cc to propose prostate biopsies to patients with negative magnetic resonance imaging: Efficient threshold or legacy of the past? |
| Abstract: | Background: A prostate-specific antigen density (PSAd) cutoff of 0.15 ng/ml/cc is a commonly recommended threshold to identify patients with negative prostate magnetic resonance imaging (MRI) who should proceed to a prostate biopsy. We were unable to find any study that explicitly examined the properties of this threshold compared with others. Objective: To investigate whether the 0.15 cutoff is justified for selecting patients at risk of harboring high-grade cancer (Gleason score ≥3 + 4) despite negative MRI. Design, setting, and participants: A cohort of 8974 prostate biopsies provided by the Prostate Biopsy Collaborative Group (PBCG) was included in the study. Outcome measurements and statistical analysis: Locally weighted scatterplot smoothing was used to investigate whether there was a change in the risk of high-grade cancer around this value. We examined whether the use of this cutoff in patients with negative MRI corresponds to a reasonable threshold probability for a biopsy (defined as a 10% risk of high-grade disease). To do so, we applied the negative likelihood ratio of MRI, calculated from eight studies on prostate MRI, to the risk curve derived from the PBCG. Results and limitations: There was no discontinuity in the risk of high-grade prostate cancer at a PSAd cutoff of 0.15. This cutoff corresponded to a probability of high-grade disease ranging from 2.6% to 10%, depending on MRI accuracy. Using 10% as threshold probability, the corresponding PSAd cutoff varied between 0.15 and 0.38, with the threshold increasing for greater MRI accuracy. Possible limitations include difference between studies on MRI and the use of ultrasound to measure prostate volume. Conclusions: The 0.15 cutoff to recommend prostate biopsies in patients with negative MRI is justified only under an extreme scenario of poor MRI properties. We recommend a value of at least ≥0.20. Our results suggest the need for future studies to look at how to best identify patients who need prostate biopsies despite negative MRI, likely by using individualized risk prediction. Patient summary: In this study, we investigated whether the commonly used prostate-specific antigen density cutoff of 0.15 is justified to identify patients with negative magnetic resonance imaging (MRI) who should proceed to a prostate biopsy. We found that this cutoff is appropriate only in case of very poor MRI quality, and a higher cutoff (≥0.20) should be used for the average MRI. © 2022 European Association of Urology |
| Keywords: | nuclear magnetic resonance imaging; magnetic resonance imaging; prostate specific antigen; pathology; diagnostic imaging; prostate-specific antigen; prostatic neoplasms; prostate; prostate tumor; prostate biopsy; magnetic resonance spectroscopy; nuclear magnetic resonance spectroscopy; procedures; clinical decision-making; image guided biopsy; image-guided biopsy; humans; human; male; prostatic cancer; prostate-specific antigen density |
| Journal Title: | European Urology Focus |
| Volume: | 9 |
| Issue: | 2 |
| ISSN: | 2405-4569 |
| Publisher: | Elsevier B.V. |
| Date Published: | 2023-03-01 |
| Start Page: | 291 |
| End Page: | 297 |
| Language: | English |
| DOI: | 10.1016/j.euf.2022.10.002 |
| PUBMED: | 36270887 |
| PROVIDER: | scopus |
| PMCID: | PMC10578357 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 May 2023 -- Source: Scopus |
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