ArticleTranslational andrology and urology2018
Reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSA-density, with different thresholds for significant disease.
Article in Translational andrology and urology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
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Who cites it
34 citing papers in PubMed.
- Predicting clinically significant prostate cancer in PI-RADS 3 lesions: an internally validated PSA density-based model with decision-curve analysis.International urology and nephrology · 2026Article
- Urinary Biomarkers in Urological Oncology: From Biological Origin to Clinical Decision-Making-A Narrative Review.Diagnostics (Basel, Switzerland) · 2026Review
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- Personalized risk-adapted models in prostate cancer during active surveillance using MRI-a narrative review.European radiology · 2025Review
- The presence of prostate MRI-visible lesions at follow-up biopsy as a risk factor for histopathological upgrading during active surveillance.Abdominal radiology (New York) · 2025Article
- Improving Clinically Significant Prostate Cancer Detection with a Multimodal Machine Learning Approach: A Large-Scale Multicenter Study.Radiology. Imaging cancer · 2025Article
- Optimal PSA density threshold for prostate biopsy in benign prostatic obstruction patients with elevated PSA levels but negative MRI findings.BMC urology · 2025Article
- Evaluation of blood and urine based biomarkers for detection of clinically-significant prostate cancer.Prostate cancer and prostatic diseases · 2025Review
- Management of Patients With a Negative Multiparametric Prostate MRI Examination:AJR. American journal of roentgenology · 2024Review
- Evaluation of Proclarix in the diagnostic work-up of prostate cancer.BJUI compass · 2024Article
- The evolving landscape: magnetic resonance imaging in active surveillance for prostate cancer management.Frontiers in urology · 2024Review
- Clinical and prostate multiparametric magnetic resonance imaging findings as predictors of general and clinically significant prostate cancer risk: A retrospective single-center study.Current urology · 2023Article
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- Article
- Magnetic Resonance Imaging-guided Active Surveillance of Prostate Cancer: Time to Say Goodbye to Protocol-based Biopsies.European urology open science · 2022Article
- Article
- Active Surveillance Strategies for Low-Grade Prostate Cancer: Comparative Benefits and Cost-effectiveness.Radiology · 2021Article
- When to biopsy Prostate Imaging and Data Reporting System version 2 (PI-RADSv2) assessment category 3 lesions? Use of clinical and imaging variables to predict cancer diagnosis at targeted biopsy.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2021Article
- Diagnosis of Prostate Cancer in Patients with Prostate-Specific Antigen (PSA) in the Gray Area: Construction of 2 Predictive Models.Medical science monitor : international medical journal of experimental and clinical research · 2021Article
- Systematic and MRI-Cognitive Targeted Transperineal Prostate Biopsy Accuracy in Detecting Clinically Significant Prostate Cancer after Previous Negative Biopsy and Persisting Suspicion of Malignancy.Medicina (Kaunas, Lithuania) · 2021Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe fear of undergrading prostate cancer (PCa) in men on active surveillance (AS) have led to strict criteria for monitoring, which have resulted in good long-term cancer-specific survival, proving the safety of this approach. Reducing undergrading, MRI-targeted biopsies are increasingly used in men with low-risk disease despite their undefined role yet. The objective of this study is to investigate the rate of upgrading using MRI-targeted biopsies in men with low-risk disease on AS, stratified on the basis of PI-RADS and PSA-density, with the aim to reduce potential unnecessary repeat biopsy procedures.
methodsA total of 331 men were prospectively enrolled following the MRI-PRIAS protocol. MR imaging was according to Prostate Imaging Reporting and Data System (PI-RADSv2) guidelines. Suspicious MRI lesions (PI-RADS 3-5) were additionally targeted by MRI-TRUS fusion biopsies. Outcome measure was upgrading to Gleason score (GS) ≥3+4 with MRI-targeted biopsies, stratified for PI-RADS and PSA-density.
resultsIn total, 25% (82/331) of men on AS showed upgrading from GS 3+3. Only 3% (11/331) was upgraded to GS ≥8. In 60% (198/331) a suspicious MRI lesion was identified, but in only 41% (82/198) of men upgrading was confirmed. PI-RADS 3, 4 and 5 categorized index lesions, showed upgrading in 30%, 34% and 66% of men, respectively. Stratification to PI-RADS 4-5, instead of PI-RADS 3-5, would have missed a small number of high volume Gleason 4 PCa in PI-RADS 3 category. However, further stratification into PI-RADS 3 lesions and PSA-density <0.15 ng/mL
conclusionsStratification with the combination of PI-RADS and PSA-density may reduce unnecessary additional MRI biopsy testing. Overall, the high rate of detected upgrading in men on AS may result in an unintended tightening of continuing in AS. Since patients, included under current AS criteria showed extremely favorable outcome, there might be no need to further restrict continuing on AS with MRI and targeted biopsies.
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