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Usefulness of Prostate-Specific Antigen Density as an Indicator for Recommending Prebiopsy Magnetic Resonance Imaging to Prevent Missed Prostate Cancer Diagnoses

 Jin Hyung Jeon  ;  Kyo Chul Koo  ;  Byung Ha Chung  ;  Kwang Suk Lee 
 Korean Journal of Urological Oncology, Vol.19(3) : 155-163, 2021-08 
Journal Title
Korean Journal of Urological Oncology(대한비뇨기종양학술지)
Issue Date
Magnetic resonance imaging ; Prostate cancer ; Prostate-specific antigen
Purpose: To identify the indication for recommending prebiopsy magnetic resonance imaging
(MRI) to prevent prostate cancer missed diagnoses in cases without prebiopsy MRI.
Materials and Methods: Between January 2017 and September 2020, 585 patients suspected
with prostate cancer underwent prostate biopsy after MRI. For patients with visible lesions, MRI targeted biopsy using an image-based fusion program was performed in addition to the 12-
core systematic biopsy. Patients for whom MRI was performed in other institutions (n=4) and
patients who underwent target biopsy alone (n=7) were excluded.
Results: Of 574 patients (median prostate-specific antigen [PSA] level, 6.88 ng/mL; mean age,
68.2 years), 342 (59.6%) were diagnosed with prostate cancer (visible lesions=312/449 [69.5%];
nonvisible lesions=30/123 [24.0%]). The detection rates of visible lesions stratified using the
Prostate Imaging Reporting and Data System score (3 vs. 4 vs. 5) were 30.9% (54 of 175), 61.2%
(150 of 245), and 90.1% (127 of 141), respectively. Multivariate analysis showed that PSA density
was a significant factor for presence of visible lesions, prostate cancer, and significant prostate
cancer diagnosis. Among patients with positive lesions, 27 (8.2%) were diagnosed with prostate
cancer concomitant with negative systematic biopsy results. A PSA density of 0.15 ng/mL/cm3
was identified as the significant cutoff value for predicting positive target biopsy in groups with
negative systematic biopsy. Sixty of the negative target lesions (26.1%) were diagnosed using
systematic biopsy.
Conclusions: To maximize cancer detection rates, both targeted and systematic biopsies
should be implemented. PSA density was identified as a useful factor for recommending prebi opsy MRI to patients suspected with prostate cancer.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koo, Kyo Chul(구교철) ORCID logo https://orcid.org/0000-0001-7303-6256
Lee, Kwang Suk(이광석) ORCID logo https://orcid.org/0000-0002-7961-8393
Jeon, Jinhyung(전진형)
Chung, Byung Ha(정병하) ORCID logo https://orcid.org/0000-0001-9817-3660
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