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MRI + Blood Test Results May Cut Unnecessary Biopsies for Prostate Cancer

Patient-tailored biopsy decisions still maintain high sensitivity

By Lori Solomon HealthDay Reporter

TUESDAY, April 2, 2024 (HealthDay News) — Prostate biopsies may not be necessary for patients with equivocal or negative magnetic resonance imaging (MRI) results and low prostate-specific antigen density (PSAD), according to a study published online March 29 in JAMA Network Open.

Arya Haj-Mirzaian, M.D., from Brigham and Women’s Hospital in Boston, and colleagues conducted a systematic literature review to determine the optimal prostate biopsy decision-making strategy for avoiding unnecessary biopsies and minimizing the risk for missing clinically significant prostate cancer (csPCa) by combining the MRI Prostate Imaging Reporting & Data System (PI-RADS) and clinical data.

Based on 72 included studies (36,366 patients), the researchers found that PI-RADS category 4 lesions (β-coefficient, 7.82) and category 5 lesions (β-coefficient, 23.18) were significantly associated with a higher risk for csPCa. When considered jointly in a multivariable model, the only clinical variable significantly associated with csPCa besides PI-RADS category 5 lesions (β-coefficient, 9.19) was PSAD (β-coefficient, 15.50). There was a 30 percent reduction in unnecessary biopsies by avoiding biopsy in patients with lesions with PI-RADS category ≤3 and PSAD <0.10 ng/mL2 compared with performing biopsy in all suspected patients. This strategy had an estimated sensitivity of 97 percent (versus 95 percent with performing biopsy in all suspected patients) and a number needed to harm of 17 (versus 15).

“These findings suggest that in patients with suspected csPCa, patient-tailored prostate biopsy decisions based on PI-RADS and PSAD could prevent unnecessary procedures while maintaining high sensitivity,” the authors write.

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