Prostate International · Published 2026-01-01 · DOI 10.1016/j.prnil.2025.12.006
Purpose: PI-RADS 3 lesions represent a diagnostic challenge in repeat prostate biopsy. We investigated whether PI-RADS 3 independently predicts negative biopsy outcomes and how PSA density (PSAD) modifies cancer detection across PI-RADS categories. Materials and methods: We retrospectively analyzed 684 patients who underwent repeat MRI-guided prostate biopsy between 2015 and 2022. PI-RADS scores, clinicopathologic variables, biopsy Gleason Scores, and radical prostatectomy findings were assessed. Univariate and multivariate logistic regression identified predictors of positive biopsy. Subgroup analysis examined detection rates stratified by PI-RADS and PSAD. Results: Overall, 238 patients (34.8 %) had positive biopsies. PI-RADS 3 was identified in 210 patients (30.7 %) and PI-RADS 4-5 in 274 (40.1 %). Cancer detection differed significantly: 19.0 % for PI-RADS 3 versus 51.8 % for PI-RADS 4-5 (P < 0.001). Multivariate analysis confirmed PI-RADS 3 as an independent predictor of negative biopsy (OR 0.582, 95 % CI 0.364-0.929, P = 0.023), while PI-RADS 4-5 predicted positive biopsy (OR 2.438, P < 0.001). PSAD strongly stratified risk in PI-RADS 4-5 lesions (33.8 % vs 62.4 %, P < 0.001) but showed minimal effect in PI-RADS 3 lesions (16.2 % vs 20.7 %, P = 0.564). Conclusion: PI-RADS 3 lesions independently predict negative biopsy in repeat MRI-guided prostate biopsy. PSAD demonstrates differential predictive utility across PI-RADS categories. Risk-stratified management incorporating imaging and clinical biomarkers may optimize decision-making while minimizing unnecessary procedures.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →