Abstract
Background: Previous studies have identified various predictors for clinically significant prostate cancer in biopsy-naïve patients.
Aims: To identify clinical variables associated with clinically significant prostate cancer diagnosis using systematic biopsy combined with cognitive targeted biopsy.
Methods: This retrospective study analyzed data from 76 biopsy-naïve men who underwent systematic biopsy combined with cognitive targeted biopsy due to Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesions detected on prebiopsy prostate multiparametric magnetic resonance imaging between March 2020 and September 2022. Binary logistic regression was used to identify independent predictors of clinically significant prostate cancer, with odds ratio and 95% confidence intervals.
Results: The overall detection rate for clinically significant prostate cancer was 44.7%. In univariable analyses, prostate-specific antigen density ≥0.16 ng/ml2 (odds ratio 57.6 [95% confidence intervals 7.13-464.77]), PI-RADS 5 (odds ratio 10.41 [95% confidence intervals 3.47-31.2]), peripheral zone lesions (odds ratio 3.85 [95% confidence intervals 1.32-11.24]), and biopsy density ≥ 0.26 core/ml (odds ratio 2.95 [95% confidence intervals 1.09-8.01]) were significantly associated with clinically significant prostate cancer (p<0.05) and were entered to multivariable analysis. Considering p<0.2 for selecting variables for multivariable analysis, a single lesion (odds ratio 2.09 [95% confidence intervals 0.81-5.34]) and transition zone lesions (odds ratio 0.45 [95% confidence intervals 0.17-1.14) were also included. According to Multivariable analysis results, prostate-specific antigen density ≥0.16 ng/ml2 (odds ratio 49.88 [95% confidence intervals 4.96-501.47]) and PI-RADS 5 (odds ratio 19.89 [95% confidence intervals 3.36-117.55]) were significant independent predictors of clinically significant prostate cancer, while peripheral zone lesions (odds ratio 0.97 [95% confidence intervals 0.09-10.05]), biopsy density ≥0.26 core/ml (odds ratio 3.44 [95% confidence intervals 0.46-25.68]), a single lesion (odds ratio 3.34 [95% confidence intervals 0.72-15.5]), and transition zone lesions (odds ratio 1.18 [95% confidence intervals 0.15-8.88]) were not.
Conclusions: The clinical implementation of PI-RADS version 2.1 combined with systematic biopsy combined with cognitive targeted biopsy yielded an acceptable overall detection rate for clinically significant prostate cancer. Moreover, PI-RADS 5 and prostate-specific antigen density ≥0.16 ng/ml2 were significant predictors of positive systematic biopsy combined with cognitive targeted biopsy results.