A strategy to reduce unnecessary prostate biopsies in patients with tPSA >10 ng ml -1 and PI-RADS 1-3.

Qi-Fei DONG; Yi-Xun LIU; Yu-Han CHEN; Yi-Fan MA; Tao ZHOU; Xue-Feng FAN; Xiang YU; Chang-Ming WANG; Jun XIAO

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A strategy to reduce unnecessary prostate biopsies in patients with tPSA >10 ng ml -1 and PI-RADS 1-3.

Author: Qi-Fei DONG ¹ ; Yi-Xun LIU ¹ ; Yu-Han CHEN ¹ ; Yi-Fan MA ¹ ; Tao ZHOU ¹ ; Xue-Feng FAN ¹ ; Xiang YU ¹ ; Chang-Ming WANG ¹ ; Jun XIAO ¹
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1. Department of Urology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
Publication Type:Journal Article
Keywords: clinically significant prostate cancer; overdiagnosis; prostate biopsy; risk stratification
MeSH: Humans; Male; Prostatic Neoplasms/diagnostic imaging*; Prostate-Specific Antigen/blood*; Aged; Middle Aged; Retrospective Studies; Prostate/diagnostic imaging*; Unnecessary Procedures/statistics & numerical data*; Biopsy/statistics & numerical data*; China; ROC Curve
From: Asian Journal of Andrology 2025;27(4):531-536
CountryChina
Language:English
Abstract: We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen (tPSA) >10 ng ml -1 and Prostate Imaging Reporting and Data System (PI-RADS) scores between 1 and 3. Clinical data derived from 517 patients of The First Affiliated Hospital of USTC (Hefei, China) from January 2020 to December 2023 who met the screening criteria for the study were retrospectively collected. Independent predictors were identified via univariate and multivariate logistic regression analysis. The diagnostic capacity of clinical variables was evaluated using the receiver operating characteristic (ROC) curves and area under the curve (AUC). A prostate biopsy strategy was developed via risk stratification. Of the 517 patients, 17/348 (4.9%) with PI-RADS 1-2 were diagnosed with clinically significant prostate cancer (csPCa), and 27/169 (16.0%) patients with PI-RADS 3 were diagnosed with csPCa. The appropriate prostate-specific antigen density (PSAD) cut-off values were 0.45 ng ml -2 for PI-RADS 1-2 patients and 0.3 ng ml -2 for PI-RADS 3 patients. The appropriate prostate volume (PV) cut-off values were 40 ml for PI-RADS 1-2 patients and 50 ml for PI-RADS 3 patients. The prostate biopsy strategy based on PSAD and PV developed in this study can reduce unnecessary prostate biopsies in patients with tPSA >10 ng ml -1 and PI-RADS 1-3. In the study, 66.5% (344/517) patients did not need to undergo prostate biopsy, at the expense of missing only 1.7% (6/344) patients with csPCa.