A PSMA PET/CT based risk model for prediction of concordance between targeted biopsy and combined biopsy in detecting prostate cancer

Backgroud mpMRI-TB improves the clinically significant prostate cancer (csPCa) detection rate. However, there has been none consensus regarding the avoidance of systematic biopsy (SB) with more biopsy cores in patients undergoing mpMRI-TB. Thus, this study is to investigate the diagnostic value of ⁶⁸Ga-PSMA-11 in predicting the concordance between mpMRI-TB and combined biopsy (CB) in detecting PCa. Methods 115 consecutive men with ⁶⁸Ga-PSMA-11 PET/CT prior to prostate biopsy were included for analysis. PSMA intensity, quantified as maximum standard uptake value (SUVmax), minimum apparent diffusion coefficient (ADCmin) and other clinical characteristics were evaluated relative to biopsy concordance by using univariate and multivariate logistic regression analyses. A prediction model was developed based on the identified parameters. Results concordance between mpMRI-TB and CB occurred in 76.5% (88/115) of the patients. Multivariate logistic regression analyses performed that SUVmax (OR = 0.952; 95% CI: 0.917–0.988; p = 0.010) and ADCmin (OR = 1.006; 95% CI: 1.003–1.010; p = 0.001) were independent risk factors for biopsy concordance. The developed model showed a sensitivity, specificity, accuracy and AUC of 0.67, 0.78, 0.81 and 0.78 in the full sample. Conclusions The developed prediction model based on SUVmax and ADCmin showed practical value in guiding the optimization of prostate biopsy pattern. Lower SUVmax and Higher ADCmin values are associated with greater confidence in implementing mono-TB and safely avoiding SB, effectively balancing benefits and risks.