Evie Nguyen1, Imon Banerjee1,2, Meghana Nadella1, Jacob Varner3, Naoki Takashashi4, Jordan LeGout5, Melissa Stanton1, Daniel Frendl1, Haider Abdul-Mush1, and Nelly Tan1
1Mayo Clinic AZ, Phoenix, AZ, United States, 2Arizona State University, Phoenix, AZ, United States, 3Mayo Clinic AZ, Phenix, AZ, United States, 4Mayo Clinic Rochester, Rochester, MN, United States, 5Mayo Clinic FL, Jacksonville, FL, United States
Synopsis
Keywords: Prostate, Cancer, prostate cancer, discordant radiology pathology
Motivation: To understand the risk of clinically significant prostate cancer (csPCa) in patients with negative biopsies for PIRADS categories 4 and 5 lesions, addressing a critical gap in clinical decision-making following discordant prostate MRI-biopsy findings.
Goal(s): To determine the prevalence of csPCa among patients with negative biopsy for PIRADS 4 or 5 lesions.
Approach: A multicenter retrospective study, utilizing Natural Language Processing (NLP) to analyze patient demographics, clinical, imaging and pathologic outcomes, followed by statistical analyses.
Results: In 44% patients was found to have csPCa after initial discordant prostate MRI- biopsy.
Impact: This study underscores the high risk of csPCa in patients with initial negative biopsies for PIRADS 4 or 5 lesions, potentially guiding clinicians in patient management and informing follow-up strategies.
Objective
Objective: To assess the prevalence of clinically
significant prostate cancer (csPCa) in patients with initial negative prostate
biopsies for PIRADS categories 4 and 5 lesions.
Methods:
A HIPAA-compliant, IRB-approved, retrospective multicenter study from 2017-2023. We focused on patients with elevated PSA, PIRADS 4 or 5 lesions, initial negative biopsies, and subsequent biopsies. Data extraction included patients' demographics, PSA levels, lesion characteristics, and Gleason grade group (GG). Natural Language Processing (NLP) models were trained and validated to extract structured data from radiology and pathology reports. Statistical analyses used Mann-Whitney U and Chi-square tests, with a significance threshold of P<0.05. Results
23665 MRI exams were performed on 19257 patients across 4 regions. Of these 5394 /19257 (28.0%) patients had MRI before the biopsy. “Elevated PSA” was the indication in 3168 / 5394 (58.7%) of the patients. 3054/3168 patients had subsequent biopsy results. PIRADS category 4 was reported in 1130/3054 (37.0%) patients, and category 5 in 724/3054 (23.7%) patients. 202/1130 (17.9%) of PIRADS 4 and 37/724 (5.1%) patients PIRADS 5 had subsequent benign prostate biopsy, for a total of 239 / 1854 (12.9%) category 4/5 patients with negative biopsy after a median of 39.5 months of follow up. 25 /239 (10.5%) had follow up subsequent prostate biopsy. On follow up biopsy, 7/25 (28%) had benign biopsy, 7/25 (28%) had GG1, 5/25 (20%) had GG2, 1/25 (4%) had GG3, 2/25 (8.0%) had GG4, and 3/25 (125) had GG5, for a total of 11/25 (44%) with clinically significant prostate cancer (GG2-5). No significant differences were observed in age (62.5 vs 67, p=0.09, PSAD (0.105 vs 0.10, p =0.91), proportion of PIRADS 5 (14.3 vs 45.4%, p=0.17), tumor volume (0.30 vs 0.63, p=0.08) and maximum size of lesion on MRI between patients who developed csPCa vs those who did not. Conclusion: 44% of patients developed csPCa after initial benign biopsy for PIRADS category 4 or 5 lesions on prostate MRIImpact:
Findings suggests risk of csPCa is high in patients with initial discordant prostate MRI-biopsy findings.Acknowledgements
No acknowledgement found.References
Wang YH, Liang C, Zhu FP, Zhou TR, Li J, Wang ZJ, Liu BJ. Improving the understanding of PI-RADS in practice: characters of PI-RADS 4 and 5 lesions with negative biopsy. Asian J Androl. 2023 Mar-Apr;25(2):217-222. doi: 10.4103/aja2022112. PMID: 36722578; PMCID: PMC10069697.
Deivasigamani S, Kotamarti S, Adams ES, Séguier D, Zhang D, Michael Z, Polascik TJ, Gupta RT. Reconciling discordance between PI-RADS 4 lesions and targeted biopsy: Early experience of a multidisciplinary quality improvement protocol with PI-RADS 4 subcategorization. Eur J Radiol. 2023 Aug;165:110929. doi: 10.1016/j.ejrad.2023.110929. Epub 2023 Jun 14. PMID: 37352682.