Objective:
To evaluate the combination of prostate-specific antigen density, multiparametric magnetic resonance imaging, and prostate-specific membrane antigen positron emission tomography/computed tomography in identifying patients with adverse prostate cancer pathology.
Approach:
- Study Design: Retrospective evaluation of 413 patients who underwent radical prostatectomy for prostate cancer, assessing clinical and imaging variables.
- Patient Characteristics: Median age of patients was 64.9 years; all patients underwent prostate biopsy.
- Adverse Pathology Definition: Defined as International Society of Urological Pathologists grade 3 or higher disease and/or extraprostatic disease of pT3 or higher or pN1.
Key Findings:
- 60% of patients had adverse pathology at radical prostatectomy.
- Adverse pathology rates were 48% for PSAD of 0.15 or lower and 72% for PSAD greater than 0.15.
- 80% of patients with PI-RADS 5 findings had adverse pathology.
- The triple-positive profile (PSAD > 0.15, PI-RADS 5, PRIMARY 5) had 100% specificity and positive predictive value, but only 9% sensitivity.
Interpretation:
The combination of PSAD, mpMRI, and PSMA PET/CT may help define a highly selected population for prospective investigation of biopsy-sparing strategies.
Limitations:
- Retrospective design with potential selection bias and unmeasured confounding.
- Highly selected and homogeneous patient population.
- Single-center design may limit generalizability.
- External validation needed before adoption in prospective studies.
Conclusion:
The study identifies a specific subgroup of patients associated with adverse pathology using a combination of imaging and clinical parameters, warranting further investigation.
Sources:
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.
