ArticleThe British journal of radiology2024
Risk stratification of prostate cancer with MRI and prostate-specific antigen density-based tool for personalized decision making.
Article in The British journal of radiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 14 citations in OpenAlex.
- Utility of PSA density velocity in diagnosing prostate cancer on prostate MR.Abdominal radiology (New York) · 2026Article
- Value of PSA density in PI-RADS 3 lesions: a single-center retrospective observational study.International urology and nephrology · 2026Observational
- The effects of prostate volume and PI-RADS category on optimal PSA-density thresholds for biopsy decision-making.European radiology · 2026Article
- Diagnostic and Clinical Impact of Imaging Modality on PSA Density: TRUS Versus MRI in Gray-Zone Prostate Cancer.Current oncology (Toronto, Ont.) · 2026Article
- Article
- Clinical and Liquid Biomarkers of 20-Year Prostate Cancer Risk in Men Aged 45 to 70 Years.JAMA network open · 2026Article
- MRI-derived T stage predicts nodal positivity on PSMA PET/CT in high-risk primary prostate cancer.Frontiers in nuclear medicine · 2026Article
- Development and external validation of a simple pre-biopsy risk stratification model for clinically significant prostate cancer in men with PI-RADS 3 lesions: a multicenter transperineal biopsy study.Frontiers in oncology · 2026Article
- Restriction Spectrum Imaging as a Quantitative Biomarker for Prostate Cancer With Reliable Positive Predictive Value.The Journal of urology · 2025Article
- Personalised Prostate Cancer Diagnosis: Evaluating Biomarker-based Approaches to Reduce Unnecessary Magnetic Resonance Imaging and Biopsy Procedures.European urology open science · 2025Review
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesMRI is now established for initial prostate cancer diagnosis; however, there is no standardized pathway to avoid unnecessary biopsy in low-risk patients. Our study aimed to test previously proposed MRI-focussed and risk-adapted biopsy decision models on a real-world dataset.
methodsSingle-centre retrospective study performed on 2055 biopsy naïve patients undergoing MRI. Diagnostic pathways included "biopsy all", "MRI-focussed" and two risk-based MRI-directed pathways. Risk thresholds were based on prostate-specific antigen (PSA) density as low (<0.10 ng mL-2), intermediate (0.10-0.15 ng mL-2), high (0.15-0.20 ng mL-2), or very high-risk (>0.20 ng mL-2). The outcome measures included rates of biopsy avoidance, detection of clinically significant prostate cancer (csPCa), missed csPCa, and overdiagnosis of insignificant prostate cancer (iPCa).
resultsOverall cancer rate was 39.9% (819/2055), with csPCa (Grade-Group ≥2) detection of 30.3% (623/2055). In men with a negative MRI (Prostate Imaging-Reporting and Data System, PI-RADS 1-2), the risk of cancer was 1.2%, 2.6%, 9.0%, and 12.9% in the low, intermediate, high, and very high groups, respectively; for PI-RADS score 3 lesions, the rates were 10.5%, 14.3%, 25.0%, and 33.3%, respectively. MRI-guided pathway and risk-based pathway with a low threshold missed only 1.6% csPCa with a biopsy-avoidance rate of 54.4%, and the risk-based pathway with a higher threshold avoided 62.9% (1292/2055) of biopsies with 2.9% (61/2055) missed csPCa detection. Decision curve analysis found that the "risk-based low threshold" pathway has the highest net benefit for probability thresholds between 3.6% and 13.9%.
conclusionCombined MRI and PSA-density risk-based pathways can be a helpful decision-making tool enabling high csPCa detection rates with the benefit of biopsy avoidance and reduced iPCa detection. ADVANCES IN KNOWLEDGE: This real-world dataset from a large UK-based cohort confirms that combining MRI scoring with PSA density for risk stratification enables safe biopsy avoidance and limits the over-diagnosis of insignificant cancers.
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