MP19-12 CHARACTERISTICS OF PI-RADS 5 LESIONS WITH A NEGATIVE OR GLEASON GRADE GROUP 1 BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP19)1 May 2024MP19-12 CHARACTERISTICS OF PI-RADS 5 LESIONS WITH A NEGATIVE OR GLEASON GRADE GROUP 1 BIOPSY Lindsey T. Webb, Gabriela M. Diaz, Eusebio Luna Velasquez, Sankalp Goberdhan, Ghazal Khajir, Vinaik Sundaresan, Michael S. Leapman, and Preston C. Sprenkle Lindsey T. WebbLindsey T. Webb , Gabriela M. DiazGabriela M. Diaz , Eusebio Luna VelasquezEusebio Luna Velasquez , Sankalp GoberdhanSankalp Goberdhan , Ghazal KhajirGhazal Khajir , Vinaik SundaresanVinaik Sundaresan , Michael S. LeapmanMichael S. Leapman , and Preston C. SprenklePreston C. Sprenkle View All Author Informationhttps://doi.org/10.1097/01.JU.0001008716.22569.77.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite a high positive predictive value for identifying clinically significant prostate cancer (PCa), up to 18% of PI-RADS (Prostate Imaging Reporting and Data System) 5 lesions are found to be benign on biopsy. However, limited information is available to help determine if a subset of PI-RADS 5 lesions will have benign or clinically insignificant pathology prior to biopsy. This study aimed to assess the presence of pre-biopsy clinical factors that could be utilized to predict a discrepancy between imaging and histopathology and thus, avoid low-yield biopsies. METHODS: From our prospectively collected database, we retrospectively reviewed 838 PI-RADS 5 lesions from 646 patients at our institution from 5/2014 to 10/2022. Demographic information, MRI information, biopsy information, and other clinical characteristics were recorded. The Gleason grade groups (GGG) were classified into benign, GGG1, and GGG2+. Multivariable logistic regression and descriptive statistics were used to assess variables associated with PCa, and chart review was used to evaluate the outcomes of patients with inflammation on biopsy. RESULTS: Of the 838 PI-RADS 5 lesions, 110 (13%) were negative for any cancer, 154 (18%) were GGG1, and 574 (68%) were GG2+. Inflammation on pathology was strongly protective against GGG1 (OR 0.141; p<0.001) and GGG2+ (0.037; p<0.001) disease. Other factors protective against GGG2+ included: TZ lesions (vs PZ) (OR 0.431; p=0.003), prior negative biopsy (OR 0.250; p<0.001), and being on active surveillance (AS) (OR 0.254; p<0.001). More lesions were associated with lower odds of GGG2+ disease: 3 (OR 0.377; p=0.009), 4 (OR 0.114; p<0.001), and 5 lesions (OR 0.052; p=0.034). Patients who are older (OR 1.067; p<0.001) with higher PSA (OR 1.101; p=0.024) were more likely to have GGG2+ cancer. A TZ lesion (NPV 81%), a prior negative biopsy (NPV 70%), being on AS (NPV 80%), and having 4+ PI-RADS 5 (NPV 86%) lesions showed weak negative predictive values for GGG2+ cancer. Of the 23 patients with inflammation, 9 had known pre-biopsy prostatitis, and only 1 of those 9 had GGG1 or GGG2+ disease. Of the 7 patients who had subsequent MRIs, only 1 was biopsied due to the patients' known prior inflammation. CONCLUSIONS: In men with PI-RADS 5 lesions, there are few pre-biopsy characteristics that could preclude the need for biopsy. However, the presence of inflammation is associated with very low likelihood for the presence of GG2+ disease. Development of pre-biopsy characteristics that identify/predict inflammation may allow improved risk stratification and some men to avoid unnecessary prostate biopsy. Source of Funding: Yale Department of Urology © 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 Lindsey T. Webb More articles by this author Gabriela M. Diaz More articles by this author Eusebio Luna Velasquez More articles by this author Sankalp Goberdhan More articles by this author Ghazal Khajir More articles by this author Vinaik Sundaresan More articles by this author Michael S. Leapman More articles by this author Preston C. Sprenkle More articles by this author Expand All Advertisement PDF downloadLoading ...