Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators
Objectives Develop risk-adapted conditional biopsy pathways utilizing MRI in combination with prostate-specific antigen (PSA) density (PSAD) and the ratio of free to total PSA (f/tPSA), respectively, to enhance the detection of clinically significant prostate cancer (csPCa) while minimizing ‘negativ...
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Taylor & Francis Group
2025-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2024.2446695 |
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| author | Pengfei Jin Ximing Wang Zhenwei Ding Liqin Yang Chenyang Xu Xu Wang Fawei Huang |
| author_facet | Pengfei Jin Ximing Wang Zhenwei Ding Liqin Yang Chenyang Xu Xu Wang Fawei Huang |
| author_sort | Pengfei Jin |
| collection | DOAJ |
| description | Objectives Develop risk-adapted conditional biopsy pathways utilizing MRI in combination with prostate-specific antigen (PSA) density (PSAD) and the ratio of free to total PSA (f/tPSA), respectively, to enhance the detection of clinically significant prostate cancer (csPCa) while minimizing ‘negative’ biopsies in low-risk patients.Methods The Prostate Imaging Reporting and Data System (PI-RADS) category, PSAD, f/tPSA and biopsy-pathology of 1018 patients were collected retrospectively. Subsequently, PSAD and f/tPSA were divided into four intervals, which were then combined with the MRI findings to construct two risk stratification matrix tables. Six biopsy decision pathways were established: three clinical pathways based solely on PSAD and f/tPSA, and three MRI-combined pathways incorporating both PI-RADS and PSA-derived indicators. The biopsy and clinically insignificant PCa (ciPCa) avoidance, csPCa detection rate, and ‘negative’ biopsies proportion were assessed. Decision curve analysis (DCA) was employed to evaluate the net benefit associated with each pathway.Results When reporting PI-RADS 1 - 2, PSAD ≥ 0.20 ng/ml/cm3 or f/tPSA ≤ 0.10 were found to be useful for patient stratification. When reporting PI-RADS 3, PSAD ≥ 0.10 − 0.15 ng/ml/cm3 and f/tPSA ≤ 0.16 − 0.25 were helpful in distinguishing the risk of csPCa. The three MRI-combined pathways showed higher csPCa detection rates (94% to 96%) than the three clinical pathways (85% to 91%); ‘MRI + PSAD + f/tPSA’ demonstrated a high csPCa detection rate of 94% while maintaining the maximum biopsy avoidance and lowest ‘negative’ biopsy proportion of 40% and 25%, respectively. The DCA showed significantly higher net benefits for three MRI-combined pathways compared to all clinical pathways.Conclusions The integration of MRI and PSA-derived indicators enables effective patient risk stratification, thereby providing valuable decision-making pathways to enhance the management of csPCa while minimizing ‘negative’ biopsies. |
| format | Article |
| id | doaj-art-b2e370f2ce1a4355874e9a1f895e89e8 |
| institution | Kabale University |
| issn | 0785-3890 1365-2060 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Annals of Medicine |
| spelling | doaj-art-b2e370f2ce1a4355874e9a1f895e89e82025-01-02T00:01:28ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2024.2446695Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicatorsPengfei Jin0Ximing Wang1Zhenwei Ding2Liqin Yang3Chenyang Xu4Xu Wang5Fawei Huang6Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Radiology, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Radiology, The Second People’s Hospital of Wuhu, Wuhu, ChinaDepartment of Radiology, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, ChinaDepartment of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Radiology, Pinghu Hospital of Traditional Chinese Medicine, Pinghu, ChinaObjectives Develop risk-adapted conditional biopsy pathways utilizing MRI in combination with prostate-specific antigen (PSA) density (PSAD) and the ratio of free to total PSA (f/tPSA), respectively, to enhance the detection of clinically significant prostate cancer (csPCa) while minimizing ‘negative’ biopsies in low-risk patients.Methods The Prostate Imaging Reporting and Data System (PI-RADS) category, PSAD, f/tPSA and biopsy-pathology of 1018 patients were collected retrospectively. Subsequently, PSAD and f/tPSA were divided into four intervals, which were then combined with the MRI findings to construct two risk stratification matrix tables. Six biopsy decision pathways were established: three clinical pathways based solely on PSAD and f/tPSA, and three MRI-combined pathways incorporating both PI-RADS and PSA-derived indicators. The biopsy and clinically insignificant PCa (ciPCa) avoidance, csPCa detection rate, and ‘negative’ biopsies proportion were assessed. Decision curve analysis (DCA) was employed to evaluate the net benefit associated with each pathway.Results When reporting PI-RADS 1 - 2, PSAD ≥ 0.20 ng/ml/cm3 or f/tPSA ≤ 0.10 were found to be useful for patient stratification. When reporting PI-RADS 3, PSAD ≥ 0.10 − 0.15 ng/ml/cm3 and f/tPSA ≤ 0.16 − 0.25 were helpful in distinguishing the risk of csPCa. The three MRI-combined pathways showed higher csPCa detection rates (94% to 96%) than the three clinical pathways (85% to 91%); ‘MRI + PSAD + f/tPSA’ demonstrated a high csPCa detection rate of 94% while maintaining the maximum biopsy avoidance and lowest ‘negative’ biopsy proportion of 40% and 25%, respectively. The DCA showed significantly higher net benefits for three MRI-combined pathways compared to all clinical pathways.Conclusions The integration of MRI and PSA-derived indicators enables effective patient risk stratification, thereby providing valuable decision-making pathways to enhance the management of csPCa while minimizing ‘negative’ biopsies.https://www.tandfonline.com/doi/10.1080/07853890.2024.2446695Prostate cancermagnetic resonance imagingprostate-specific antigen densitythe ratio of free to total prostate-specific antigenbiopsy indicator |
| spellingShingle | Pengfei Jin Ximing Wang Zhenwei Ding Liqin Yang Chenyang Xu Xu Wang Fawei Huang Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators Annals of Medicine Prostate cancer magnetic resonance imaging prostate-specific antigen density the ratio of free to total prostate-specific antigen biopsy indicator |
| title | Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators |
| title_full | Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators |
| title_fullStr | Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators |
| title_full_unstemmed | Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators |
| title_short | Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators |
| title_sort | development and validation of risk stratified biopsy decision pathways incorporating mri and psa derived indicators |
| topic | Prostate cancer magnetic resonance imaging prostate-specific antigen density the ratio of free to total prostate-specific antigen biopsy indicator |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2024.2446695 |
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