Utility of PSA density in patients with PI-RADS 3 lesions across a large multi-institutional collaborative

Johnathan Drevik, Zafardjan Dalimov, Robert Uzzo, John Danella, Thomas Guzzo, Lawrence Belkoff, Jay Raman, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Eric A. Singer, Kaynaat Syed, Bruce Jacobs, Andres Correa, Marc Smaldone, Serge Ginzburg

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Introduction: Prostate MRI detecting PI-RADs = 3 lesions has low diagnostic utility for prostate malignancy. Use of PSA density has been suggested to further risk-stratify these men, to potentially avoid biopsies in favor of monitoring. We evaluate the ability of PSA density (PSAd) to risk-stratify PIRADs 3 lesions across patients who underwent a prostate biopsy in a large multi-institutional collaborative. Materials and Methods: Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement collaborative of 11 academic and community urology practices in Pennsylvania and New Jersey. A retrospective analysis was performed on all patients in the PURC database that had a prostate MRI with PI-RADs 3 lesions only. PSA just before the MRI and prostate size reported on MRI were used to calculate the PSA. Clinicopathologic data were evaluated. Univariable analysis using Chi-Square and Kruskal Wallis tests and multivariable logistic regression were used to identify predictors of any PCa, and clinically significant prostate cancer (csPCa) was defined as ≥ Grade Group 2 (GG2.) Results: Between May 2015 and March 2021, 349 patients with PIRADs 3 lesions only were identified and comprised the cohort of interest. Median PSA was 5.0 with a prostate volume of 58cc and a median PSA density of 0.11, 10.6% of the cohort was African American with 81.4% being Caucasian. Significant prostate cancer was detected in 70/349 (20.0%) men. Smaller prostate volume, abnormal DRE, and higher PSAd were significantly associated with clinically significant prostate cancer on univariable analysis. In men with PSAd <0.15, 31/228 (13.6%) harbored csPCa. Multivariable analysis confirmed that men with PSAd >0.15 were more likely to harbor clinically significant prostate cancer (P < 0.001). Conclusion: Across a large regional collaborative, patients with PIRADs 3 lesions on mpMRI were noted to have clinically significant cancer in 20% of biopsies. Using a PSA density cut-off of 0.15 may result in missing clinically significant prostate cancer in 13.6%. This information is useful for prebiopsy risk stratification and counseling.

Original languageEnglish (US)
Pages (from-to)490.e1-490.e6
JournalUrologic Oncology: Seminars and Original Investigations
Issue number11
StatePublished - Nov 2022

All Science Journal Classification (ASJC) codes

  • Oncology
  • Urology


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