Combination of biparametric magnetic resonance imaging with prostate‐specific antigen density to stratify the risk of significant prostate cancer: Initial biopsy and long‐term follow‐up results

Objectives To assess whether the combination of biparametric magnetic resonance imaging with prostate‐specific antigen density can properly stratify the risk of significant prostate cancer in patients undergoing prostate biopsies and how this approach affects the detection of prostate cancer during follow‐up in patients who do not undergo prostate biopsy. Methods In total, 411 biopsy‐naïve patients who had elevated prostate‐specific antigen levels and then underwent biparametric magnetic resonance imaging for suspicious prostate cancer were analyzed: 203 patients underwent prostate biopsies, whereas 208 patients did not. Significant prostate cancer detection rates stratified by the combination of Prostate Imaging Reporting and Data System score and prostate‐specific antigen density were assessed in patients who underwent prostate biopsies. The cumulative incidence of prostate cancer detection during the follow‐up was assessed in patients who omitted biopsy. Results The negative predictive value for significant prostate cancer was 89% for Prostate Imaging Reporting and Data System scores 1–3, which increased to 97% when prostate‐specific antigen density <0.15 ng/ml/cm 3 was combined. Among patients who did not undergo biopsy, patients with Prostate Imaging Reporting and Data System scores 1–3 plus prostate‐specific antigen density <0.15 ng/ml/cm 3 included significantly less cases in which significant prostate cancer was detected during the follow‐up, compared with the others (3.2% versus 17% at 36 months). Conclusions Restriction of prostate biopsies to patients with Prostate Imaging Reporting and Data System scores 4–5 or prostate‐specific antigen density ≥0.15 ng/ml/cm 3 proved to be the good biopsy strategy, effectively balancing risks and benefits.