Utility of Prostate Health Index Density for Biopsy Strategy in Biopsy‐Naïve Patients With PI‐RADS v2.1 Category 3 Lesions

• Published in: Journal of magnetic resonance imaging 2024-10, Vol.60 (4), p.1628-1636
• Main Authors: Kim, Min Je, Park, Jung Jae, Kang, Kyung A, Park, Sung Yoon, Kim, Chan Kyo
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers; Biopsy; Decisions; Density; Diffusion rate; Field strength; Humans; Lesions; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Middle Aged; PI‐RADS; Population studies; Prostate - diagnostic imaging; Prostate - pathology; Prostate cancer; prostate health index density; Prostate-Specific Antigen - blood; prostate‐specific antigen density; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retrospective Studies; Risk; Risk groups; ROC Curve; Sensitivity and Specificity; Statistical analysis; Statistical tests
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.29268

Background Category 3 lesions in PI‐RADSv2.1 pose diagnostic challenges, complicating biopsy decisions. Recent biomarkers like prostate health index (PHI) have shown higher specificity in detecting clinically significant prostate cancer (csPCa) than prostate‐specific antigen (PSA). Yet their integration with MRI remains understudied. Purpose To evaluate the utility of PSA and PHI with its derivatives for detecting csPCa in biopsy‐naïve patients with category 3 lesion on initial prostate MRI scan. Study Type Retrospective. Population One hundred ninety‐three biopsy‐naïve patients who underwent MRI, PSA, and PHI testing, followed by both targeted and systematic biopsies. Field Strength/Sequence Turbo spin‐echo T2‐weighted imaging, diffusion‐weighted single‐shot echo‐planar imaging, and dynamic contrast‐enhanced T1‐weighted fast field echo sequence imaging in 3 T. Assessment PHI density (PHID) and PSA density (PSAD) derived by dividing serum PHI and PSA with prostate volume (MRI based methodology suggested by PI‐RADSv2.1). Risk‐stratified models to evaluate the utility of markers in triaging patients for biopsy, including low‐, intermediate‐, and high‐risk groups. Statistical Tests Independent t‐test, Mann–Whitney U test, Mantel–Haenszel test, generalized estimating equation, and receiver operating characteristic (ROC) curve analysis were used. Statistical significance defined as P