Insights on detecting clinically significant prostate cancer in PI-RADS v2.1 scores of 4 and 5

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Published Oct 28, 2024
DOI: https://doi.org/10.18103/mra.v12i10.5974

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Main Article Content

Reza Habibi Tirtashi
Clinical Research Development Unit (CRDU), 5azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran; Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Narges Tamaskani
Clinical Research Development Unit (CRDU), 5azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
Fatemeh Salamat
Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Behrouz Ghazimoghaddam
Department of Urology, School of Medicine, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
Babak Niakan
Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Nematollah Nematollahi
Department of Radiology, School of Medicine, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
Mohammad Hadi Gharib, MD
Department of Radiology, School of Medicine, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.

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.

Keywords: Prostate Cancer, Clinically Significant Prostate Cancer, Multiparametric Magnetic Resonance Imaging, Prostate-Specific Antigen Density, Biopsy Density, Prostate Imaging Reporting and Data System, PI-RADS v2.1, Cancer Detection Rate

Article Details

How to Cite
TIRTASHI, Reza Habibi et al. Insights on detecting clinically significant prostate cancer in PI-RADS v2.1 scores of 4 and 5. Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5974>. Date accessed: 15 nov. 2024. doi: https://doi.org/10.18103/mra.v12i10.5974.
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Issue
Vol 12 No 10 (2024): October Issue, Issue 10, VOl.12
Section
Research Articles

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