Mp40-17 clinical and high-resolution micro-ultrasound risk factors for detecting clinically significant prostate cancer in men with pi-rads 3 lesions: update from a large single center experience

You have accessJournal of UrologyCME1 Apr 2023MP40-17 CLINICAL AND HIGH-RESOLUTION MICRO-ULTRASOUND RISK FACTORS FOR DETECTING CLINICALLY SIGNIFICANT PROSTATE CANCER IN MEN WITH PI-RADS 3 LESIONS: UPDATE FROM A LARGE SINGLE CENTER EXPERIENCE Pier Paolo Avolio, Vittorio Fasulo, Davide Maffei, Cesare Saitta, Fabio De Carne, Nicola Frego, Marco Paciotti, Massimo Lazzeri, Rodolfo Hurle, Alberto Saita, Paolo Casale, Nicolò Maria Buffi, and Giovanni Lughezzani Pier Paolo AvolioPier Paolo Avolio More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Fabio De CarneFabio De Carne More articles by this author , Nicola FregoNicola Frego More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) is an invaluable diagnostic tool in prostate biopsies (PBx) decision making. However, most Prostate Imaging–Reporting and Data System (PI-RADS) 3 lesions do not contain clinically significant prostate cancer (CSPCa; grade group ≥2). This study is an update of a previous study aimed to investigate clinical and high-resolution micro-ultrasound (microUS) derived risk factors that predict CSPCa in men with PI-RADS 3 lesions. METHODS: A total of 200 patients who underwent microUS-guided PBx with the ExactVu system for a PI-RADS 3 lesion were prospectively enrolled between October 2017 and September 2022. The Prostate Risk Identification using microUS (PRI-MUS) protocol was used to identify suspicious areas; PBx included targeted and systematic sampling. The primary endpoint was the assessment of microUS diagnostic accuracy in detecting csPCa. Secondary endpoints included determining: the proportion of patients with a PIRADS 3 lesion who may avoid PBx after microUS examination; predictors of csPCa in patients presenting with PI-RADS 3 lesions. RESULTS: Median patient age was 64 (IQR 58–69) years, median total PSA was 6 (IQR 4.5–8.4) ng/mL and median prostate volume was 51.6 (IQR 35–73.7) mL. Overall, 91 (45.5%) patients were in the repeat biopsy setting. Micro-US detected prostate lesions with a PRI-MUS score of 3, 4 and 5 in respectively 47 (35.3%), 63 (47.4%) and 23 (17.3%) patients, while in 67 (33.5%) individuals micro-US did not identify any target. Overall, 44 (22.0%) harbored csPCa. Considering csPCa detection rate, microUS showed optimal sensitivity and negative predictive value (respectively 95.4% and 97.0%), while specificity and positive predictive value were 41.6% and 31.6%, respectively. 65 (32.5%) patients with negative microUS examination could have avoided PBx with 2 (4.5%) missed csPCa. In multivariable logistic regression models (MLRMs), positive microUS, age, and PSA density ≥0.15 emerged as independent predictors of PCa. The accuracy of a model including PRI-MUS score, age, PSA density, family history and previous biopsies was 0.764 (95% CI: 0.673−0.854). CONCLUSIONS: Our update findings confirm that MicroUS could represent a helpful tool capable of discriminating patients harbouring csPCa among subjects with PI-RADS 3 lesion. Further studies are still needed to corroborate our findings and to better establish the role of this promising strategy within the diagnostic work up of PCa patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e551 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pier Paolo Avolio More articles by this author Vittorio Fasulo More articles by this author Davide Maffei More articles by this author Cesare Saitta More articles by this author Fabio De Carne More articles by this author Nicola Frego More articles by this author Marco Paciotti More articles by this author Massimo Lazzeri More articles by this author Rodolfo Hurle More articles by this author Alberto Saita More articles by this author Paolo Casale More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...