To evaluate the risk of clinically significant prostate cancer (csPCa) across a range of PSA-density (PSAd) values within each PI-RADS category and to assess the impact of prostate volume on the predictive performance of PSAd for csPCa, highlighting its significance in clinical decision-making.
Key Findings:
28–36% of men with low-likelihood MRI findings (PI-RADS ≤ 2) can avoid immediate biopsy, potentially reducing unnecessary procedures.
Detection rate of csPCa in patients with PI-RADS ≥ 3 lesions ranges from 35% to 45%, indicating a need for improved diagnostic strategies.
Approximately 55–65% of patients with positive mpMRI have negative biopsies or are diagnosed with clinically insignificant PCa, underscoring the limitations of current diagnostic criteria.
The optimal PSAd threshold for biopsy decision-making remains unclear and requires further investigation to enhance patient management.
Interpretation:
Integrating clinical parameters like PSAd with MRI findings may reduce unnecessary biopsies, but the current PSAd threshold of 0.15 ng/mL² lacks robust validation across the entire range of PSAd values, which is crucial for effective clinical application.
Limitations:
Study conducted at a single center, which may limit generalizability; multicenter studies are needed for validation.
Exclusion criteria may have led to selection bias, potentially affecting the study's findings.
Limited prior studies assessing the impact of prostate volume on PSAd performance highlight the need for further research.
Conclusion:
Further research is needed to establish optimal PSAd thresholds for biopsy decision-making across different PI-RADS categories, considering the influence of prostate volume, to improve patient outcomes.
