Abstract
Objectives
To determine whether PSA density (PSAD), can sub-stratify risk of biopsy upgrade among
men on active surveillance (AS) with normal baseline MRI.
Methods
We identified a cohort of patients with low and favorable intermediate-risk prostate
cancer on AS at two large academic centers from February 2013 - December 2017. Analysis
was restricted to patients with GG1 cancer on initial biopsy and a negative baseline
or surveillance mpMRI, defined by the absence of PI-RADS 2 or greater lesions. We
assessed ability of PSA, prostate volume and PSAD to predict upgrading on confirmatory
biopsy.
Results
We identified 98 patients on AS with negative baseline or surveillance mpMRI. Median
PSA at diagnosis was 5.8 ng/mL and median PSAD was 0.08 ng/mL/mL. Fourteen men (14.3%)
experienced Gleason upgrade at confirmatory biopsy. Patients who were upgraded had
higher PSA (7.9 vs 5.4 ng/mL, P = .04), PSAD (0.20 vs 0.07 ng/mL/mL, P < .001), and lower prostate volumes (42.5 vs 65.8 mL, P = .01). On multivariate analysis, PSAD was associated with pathologic upgrade (OR
2.23 per 0.1-increase, P = .007). A PSAD cutoff at 0.08 generated a NPV of 98% for detection of pathologic
upgrade.
Conclusion
PSAD reliably discriminated the risk of Gleason upgrade at confirmatory biopsy among
men with low-grade prostate cancer with negative MRI. PSAD could be clinically implemented
to reduce the intensity of surveillance for a subset of patients.
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Article info
Publication history
Published online: May 31, 2021
Identification
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Published by Elsevier Inc.
