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Volz Y, Apfelbeck M, Pyrgidis N, Pfitzinger PL, Berg E, Ebner B, Enzinger B, Ivanova T, Atzler M, Kazmierczak PM, Clevert DA, Stief C, Chaloupka M. The Impact of Prostate Volume on the Prostate Imaging and Reporting Data System (PI-RADS) in a Real-World Setting. Diagnostics (Basel) 2023; 13:2677. [PMID: 37627939 PMCID: PMC10453915 DOI: 10.3390/diagnostics13162677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Multiparametric magnetic resonance imaging (mpMRI) has emerged as a new cornerstone in the diagnostic pathway of prostate cancer. However, mpMRI is not devoid of factors influencing its detection rate of clinically significant prostate cancer (csPCa). Amongst others, prostate volume has been demonstrated to influence the detection rates of csPCa. Particularly, increasing volume has been linked to a reduced cancer detection rate. However, information about the linkage between PI-RADS, prostate volume and detection rate is relatively sparse. Therefore, the current study aims to assess the association between prostate volume, PI-RADS score and detection rate of csP-Ca, representing daily practice and contemporary mpMRI expertise. Thus, 1039 consecutive patients with 1151 PI-RADS targets, who underwent mpMRI-guided prostate biopsy at our tertiary referral center, were included. Prior mpMRI had been assessed by a plethora of 111 radiology offices, including academic centers and private practices. mpMRI was not secondarily reviewed in house before biopsy. mpMRI-targeted biopsy was performed by a small group of a total of ten urologists, who had performed at least 100 previous biopsies. Using ROC analysis, we defined cut-off values of prostate volume for each PI-RADS score, where the detection rate drops significantly. For PI-RADS 4 lesions, we found a volume > 61.5 ccm significantly reduced the cancer detection rate (OR 0.24; 95% CI 0.16-0.38; p < 0.001). For PI-RADS 5 lesions, we found a volume > 51.5 ccm to significantly reduce the cancer detection rate (OR 0.39; 95% CI 0.25-0.62; p < 0.001). For PI-RADS 3 lesions, none of the evaluated clinical parameters had a significant impact on the detection rate of csPCa. In conclusion, we show that enlarged prostate volume represents a major limitation in the daily practice of mpMRI-targeted biopsy. This study is the first to define exact cut-off values of prostate volume to significantly impair the validity of PI-RADS assessed in a real-world setting. Therefore, the results of mpMRI-targeted biopsy should be interpreted carefully, especially in patients with prostate volumes above our defined thresholds.
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Affiliation(s)
- Yannic Volz
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Maria Apfelbeck
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Nikolaos Pyrgidis
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Paulo L. Pfitzinger
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Elena Berg
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Benedikt Ebner
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Benazir Enzinger
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Troya Ivanova
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Michael Atzler
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Philipp M. Kazmierczak
- Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (D.-A.C.)
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (D.-A.C.)
| | - Christian Stief
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Michael Chaloupka
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
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The Role of PSA Density among PI-RADS v2.1 Categories to Avoid an Unnecessary Transition Zone Biopsy in Patients with PSA 4-20 ng/mL. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3995789. [PMID: 34671673 PMCID: PMC8523253 DOI: 10.1155/2021/3995789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/28/2021] [Indexed: 12/28/2022]
Abstract
Objective To evaluate the role of prostate-specific antigen density (PSAD) in different Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) categories to avoid an unnecessary biopsy in transition zone (TZ) patients with PSA ranging from 4 to 20 ng/mL. Materials and Methods In this retrospective and single-center study, 333 biopsy-naïve patients with TZ lesions who underwent biparametric magnetic resonance imaging (bp-MRI) were analyzed from January 2016 to March 2020. Multivariate logistic regression analyses were performed to determine independent predictors of clinically significant prostate cancer (cs-PCa). The receiver operating characteristic (ROC) curve was used to compare diagnostic performance. Results PI-RADS v2.1 and PSAD were the independent predictors for TZ cs-PCa in patients with PSA 4-20 ng/mL. 0.9% (2/213), 10.0% (7/70), and 48.0% (24/50) of PI-RADS v2.1 score 1-2, 3, and 4-5 had TZ cs-PCa. However, for patients with PI-RADS v2.1 score 1-2, there were no obvious changes in the detection of TZ cs-PCa (0.8% (1/129), 1.3% (1/75), and 0.0% (0/9)) combining with different PSAD stratification (PSAD < 0.15, 0.15-0.29, and ≥0.30 ng/mL/mL). For patients with PI-RADS v2.1 score ≥ 3, the TZ cs-PCa detection rate significantly varied according to different PSAD stratification. A PI-RADS v2.1 score 3 and PSAD < 0.15 and 0.15-0.29 ng/mL/mL had 8.6% (3/35) and 3.7% (1/27) of TZ cs-PCa, while a PI-RADS v2.1 score 3 and PSAD ≥ 0.30 ng/mL/mL had a higher TZ cs-PCa detection rate (37.5% (3/8)). A PI-RADS v2.1 score 4-5 and PSAD <0.15 ng/mL/mL had no cs-PCa (0.0% (0/9)). In contrast, a PI-RADS v2.1 score 4-5 and PSAD 0.15-0.29 and ≥0.30 ng/mL/mL had the highest cs-PCa detection rate (50.0% (10/20), 66.7% (14/21)). It showed the highest AUC in the combination of PI-RADS v2.1 and PSAD (0.910), which was significantly higher than PI-RADS v2.1 (0.889, P = 0.039) or PSAD (0.803, P < 0.001). Conclusions For TZ patients with PSA 4-20 ng/mL, PI-RADS v2.1 score ≤ 2 can avoid an unnecessary biopsy regardless of PSAD. PI-RADS v2.1 score ≥ 3 may avoid an unnecessary biopsy after combining with PSAD. PI-RADS v2.1 combined with PSAD could significantly improve diagnostic performance.
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