ArticleProstate cancer and prostatic diseases2025
Refining clinically relevant cut-offs of prostate specific antigen density for risk stratification in patients with PI-RADS 3 lesions.
Article in Prostate cancer and prostatic diseases, 2025. 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.
- Article
- Navigating Uncertainty in MRI Diagnosis: A Human-AI Collaborative Strategy for Stratifying Clinically Significant Prostate Cancer.Journal of magnetic resonance imaging : JMRI · 2026Article
- Navigating PI-RADS v2.1 in clinical practice: pitfalls, variability, and the supportive role of AI.Abdominal radiology (New York) · 2026Review
- Article
- Risk factors of negative prostate biopsies: A CHAID decision tree analysis.BJUI compass · 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
- Evolution of the prostate cancer diagnostic paradigm: integrated evidence and clinical pathways from targeted biopsy to biopsy-free strategy.Frontiers in oncology · 2026Review
- To biopsy or not biopsy, that is the question - PI-RADS 3 prostate lesions - validation of clinical and radiological parameters for biopsy decision-making.BMC urology · 2025Article
- A propensity score-matched analysis on biopsy methods: enhanced detection rates of prostate cancer with combined cognitive fusion-targeted biopsy.Asian journal of andrology · 2025Article
- Overdiagnosis and Overtreatment in Prostate Cancer.Diseases (Basel, Switzerland) · 2025Review
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34 authors.
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Abstract
backgroundProstate Imaging Reporting and Data System (PI-RADS) 3 lesions, identified through multiparametric magnetic resonance imaging (mpMRI), present a clinical challenge due to their equivocal nature in predicting clinically significant prostate cancer (csPCa). Aim of the study is to improve risk stratification of patients with PI-RADS 3 lesions and candidates for prostate biopsy.
methodsA cohort of 4841 consecutive patients who underwent MRI and subsequent MRI-targeted and systematic biopsies between January 2016 and April 2023 were retrospectively identified from independent prospectively maintained database. Only patients who have PI-RADS 3 lesions were included in the final analysis. A multivariable logistic regression analysis was performed to identify covariables associated with csPCa defined as International Society of Urological Pathology (ISUP) grade group ≥2. Performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Significant predictors were then selected for further exploration using a Chi-squared Automatic Interaction Detection (CHAID) analysis.
resultsOverall, 790 patients had PI-RADS 3 lesions and 151 (19%) had csPCa. Significant associations were observed for age (OR: 1.1 [1.0-1.1]; p = 0.01) and PSA density (OR: 1643 [2717-41,997]; p < 0.01). The CHAID analysis identified PSAd as the sole significant factor influencing the decision tree. Cut-offs for PSAd were 0.13 ng/ml/cc (csPCa detection rate of 1% vs. 18%) for the two-nodes model and 0.09 ng/ml/cc and 0.16 ng/ml/cc for the three-nodes model (csPCa detection rate of 0.5% vs. 2% vs. 17%).
conclusionsFor individuals with PI-RADS 3 lesions on prostate mpMRI and a PSAd below 0.13, especially below 0.09, prostate biopsy can be omitted, in order to avoid unnecessary biopsy and overdiagnosis of non-csPCa.
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