Prostate-Specific Antigen Density to Select Magnetic Resonance Imaging–Targeted vs Combined Biopsy for Prostate Cancer Diagnosis: A Secondary Analysis of the Trio Study

PURPOSE: The addition of systematic prostate biopsy enhances the detection of clinically significant prostate cancer compared with MRI-targeted biopsy alone. However, there is growing interest in using only MRI-targeted biopsy. We sought to evaluate PSA density (PSAD) as an adjunctive predictor of clinically significant prostate cancer detection in men undergoing combined biopsy and as a potential metric to stratify which patients may reasonably avoid systematic biopsies in favor of MRI-targeted biopsy only. MATERIALS AND METHODS: ). Secondary outcomes were the added value of systematic biopsy relative to MRI-targeted biopsy alone. RESULTS: 0.2, added detection of clinically significant cancer with systematic biopsy was low (2%, 95% CI: 0.4%-5.9%). CONCLUSIONS: , as systematic biopsy results in low rates of additional clinically significant cancer detection.