Objective: To evaluate the diagnostic value of prostate-specific antigen (PSA) density, digital rectal examination (DRE), and family history in predicting prostate cancer among patients with low-risk Prostate Imaging Reporting and Data System (PI-RADS) 1 and 2 lesions who underwent prostate biopsy. Methods: The authors retrospectively analysed 153 patients with PI-RADS 1–2 lesions who underwent systematic and/or targeted transrectal ultrasound-guided prostate biopsy at a tertiary urology centre between 2022–2024. Clinical parameters including PSA level, PSA density, prostate volume, DRE findings, and family history were recorded. Cancer detection rates and significant predictors were identified using univariate analysis and logistic regression. Diagnostic performance was assessed with receiver operating characteristic curve analysis. Results: Prostate cancer was detected in 16/153 patients (10.5%). Patients with cancer had higher PSA density, more frequent abnormal DRE findings, and a significantly higher rate of positive family history. Logistic regression revealed that abnormal DRE (odds ratio: 0.062; p=0.009) and family history (odds ratio: 0.211; p=0.014) were independent predictors of cancer detection. The combined model showed moderate diagnostic performance (area under the curve: 0.711; p=0.006). PSA density showed a trend towards significance (p=0.082), but did not reach statistical significance independently. Conclusion: Although PI-RADS 1 and 2 lesions are typically considered low-risk, the authors’ findings suggest that clinical factors such as suspicious DRE and family history significantly enhance the detection of prostate cancer in this population. Incorporating these variables into biopsy decision-making may help avoid missed diagnoses and support a more individualised approach in patients with low-risk imaging findings.
Özcan et al. (Thu,) studied this question.