Mp19-13 What Happens to Patients With a Pi-Rads 5 Lesion and a Negative Prostate Biopsy? Long Term Follow Up of a Single Institutional Experience

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP19)1 May 2024MP19-13 WHAT HAPPENS TO PATIENTS WITH A PI-RADS 5 LESION AND A NEGATIVE PROSTATE BIOPSY? LONG TERM FOLLOW UP OF A SINGLE INSTITUTIONAL EXPERIENCE Marco Paciotti, Ludovica Cella, Davide Maffei, Pier Paolo Avolio, Alessandro Uleri, Roberto Contieri, Muhannad Ajoulani, Andrea Gobbo, Stefano Moretto, Pietro Diana, Nicola Frego, Giuseppe Garofano, Edoardo Beatrici, Cesare Saitta, Vittorio Fasulo, Hurle Rodolfo, Alberto Saita, Massimo Lazzeri, Paolo Casale, Nicolò Buffi, and Giovanni Lughezzani Marco PaciottiMarco Paciotti , Ludovica CellaLudovica Cella , Davide MaffeiDavide Maffei , Pier Paolo AvolioPier Paolo Avolio , Alessandro UleriAlessandro Uleri , Roberto ContieriRoberto Contieri , Muhannad AjoulaniMuhannad Ajoulani , Andrea GobboAndrea Gobbo , Stefano MorettoStefano Moretto , Pietro DianaPietro Diana , Nicola FregoNicola Frego , Giuseppe GarofanoGiuseppe Garofano , Edoardo BeatriciEdoardo Beatrici , Cesare SaittaCesare Saitta , Vittorio FasuloVittorio Fasulo , Hurle RodolfoHurle Rodolfo , Alberto SaitaAlberto Saita , Massimo LazzeriMassimo Lazzeri , Paolo CasalePaolo Casale , Nicolò BuffiNicolò Buffi , and Giovanni LughezzaniGiovanni Lughezzani View All Author Informationhttps://doi.org/10.1097/01.JU.0001008716.22569.77.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients (pts) presenting with a PI-RADS 5 lesion on the magnetic resonance imaging (MRI), clinically significant prostate cancer (csPCa) is highly likely to be present. However, in a real-life settings, negative biopsies are not uncommon. Due to the relatively recent introduction of MRI and the limited data available, there are no recommendations for the follow-up (FU) of pts with a PI-RADS 5 lesion and a subsequent negative biopsy. In this study, we aimed to present long-term outcomes of this specific population. METHODS: We reviewed data from 876 consecutive pts scheduled for prostate biopsy due to a clinical suspicion of PCa. All pts underwent an MRI before the biopsy, which included systematic and targeted biopsy in case of suspicious MRI lesions. We assessed the presence of overall PCa and csPCa (defined as a ISUP≥2). Subsequent management and long-term outcomes for pts with a PI-RADS 5 lesion and a negative biopsy are presented. The accuracy of possible predictors for diagnosis of csPCa during the FU were examined. RESULTS: Overall, 109 (12.5%) pts initially presented with PI-RADS 5 lesions on MRI. Among these, 32 (29.4%) pts had a negative biopsy result. The mean age was 67 years (SD 59.5-71.5), the median total PSA was 7.9 ng/mL (IQR 4.8-11.6), and the median prostate volume was 67 mL (IQR 40.0-95.0). After a median FU of 50.5 months (IQR 42.5-62.5), among the 32 pts with a negative biopsy, 13 (38%) experienced a decrease in PSA levels, 11 (34%) had stable PSA levels, and 9 (28%) had increased PSA levels. During the FU, 16 (50%) underwent an additional MRI, and 10 (31%) had a ≥PI-RADS 3 lesion. Thirteen (41%) pts underwent at least one more biopsy. Four pts were diagnosed with PCa, of which three had csPCa. All of them had a suspicious lesion on the additional MRI. While MRI had a sensitivity of 100% in this population, its Positive Predictive Value (PPV) was only 30%. Among pts with a PSA density >0.15 before the repeated biopsy, 3 pts out of 6 had csPCa. When considering a PSA density >0.20 as a threshold, 3 pts out of 5 had csPCa. Therefore, a PSA density >0.20 had 100% sensitivity, 93% specificity, 60% PPV, and 100% Negative Predictive Value (NPV) in this population. CONCLUSIONS: We presented one of the studies with the longest FU on pts with a PI-RADS 5 lesion and a negative biopsy. After more than four years of median FU, these pts have a relatively low risk of receiving a diagnosis of csPCa. Along with MRI, PSA density appears to be one of the most effective tools in predicting the risk of the disease. Further studies on larger populations are needed to confirm our findings. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e315 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Marco Paciotti More articles by this author Ludovica Cella More articles by this author Davide Maffei More articles by this author Pier Paolo Avolio More articles by this author Alessandro Uleri More articles by this author Roberto Contieri More articles by this author Muhannad Ajoulani More articles by this author Andrea Gobbo More articles by this author Stefano Moretto More articles by this author Pietro Diana More articles by this author Nicola Frego More articles by this author Giuseppe Garofano More articles by this author Edoardo Beatrici More articles by this author Cesare Saitta More articles by this author Vittorio Fasulo More articles by this author Hurle Rodolfo More articles by this author Alberto Saita More articles by this author Massimo Lazzeri More articles by this author Paolo Casale More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...