ArticleProstate international2025
Usefulness of free PSA ratio to enhance detection of clinically significant prostate cancer in patients with PI-RADS<3 and PSA≤10.
Article in Prostate international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Article
- Risk stratification for repeat prostate biopsy: PI-RADS 3 lesions and the differential role of PSA density.Prostate international · 2026Article
- Diagnostic accuracy of prostate-specific antigen and prostate-specific antigen density in patients suspected of having prostate cancer in South Korea: A large, multi-institutional registry.Investigative and clinical urology · 2026Article
- Carbon footprints in the urologic field: From diagnosis to surgery.Investigative and clinical urology · 2025Review
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7 authors.
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Abstract
Background: The necessity of prostate biopsy in patients with a Prostate Imaging-Reporting and Data System (PI-RADS) score below 3 and prostate-specific antigen (PSA) levels of 4-10 ng/ml remains controversial. We tested the diagnostic performance of the free PSA ratio (%fPSA) in detecting clinically significant cancer (CSC) in patients with PI-RADS <3 and PSA ≤10 ng/ml. Methods: We analyzed 1435 prostate biopsies performed by a single operator between April 2018 and January 2023 at a single institution. PSA and free PSA results on the day of biopsy or within 1 month were used, and all biopsies were performed after prostate magnetic resonance imaging (MRI). CSC was defined as Gleason grade group ≥2. Results: Among 208 men with PI-RADS <3 and PSA ≤10 ng/ml, CSC was detected in 37 (17.8%) patients. The median age was 65 years (interquartile range [IQR] 61-71), with a median PSA level of 5.06 ng/ml (IQR 3.98-7.08) and a median %fPSA of 18.2% (IQR 13.7-22.0). The area under the curve was 0.757 (95% confidence interval, 0.674-0.841), with a %fPSA cutoff of 17.6%, sensitivity of 86.5%, specificity of 63.7%, positive likelihood ratio (LR) of 2.38, and negative LR of 0.21. CSC was diagnosed in 5 out of 114 patients (4%) with %fPSA >17.6%, compared to 32 out of 94 patients (34%) with %fPSA <17.6%. Conclusions: In patients with PI-RADS <3 and PSA ≤10 ng/ml, %fPSA values < 17.6% may facilitate early prostate cancer diagnosis in those who might not undergo biopsy based on MRI results alone. Additionally, unnecessary biopsies could be avoided in patients with elevated PSA levels when %fPSA exceeds 17.6%.
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