MRI of the prostate can provide some of this information. Still, a biopsy is traditionally needed to determine how aggressive the cancer cells look. This study tested a new approach: combining MRI-based prostate imaging reporting and data system (PI-RADS) scores with prostate-specific antigen (PSA) density to determine which cancers were likely to be clinically significant without including information from a biopsy. PI-RADS scores the prostate lesion from 1 (highly unlikely to be clinically significant) to 5 (cancer is highly likely to be clinically significant). PSA density (PSAD) is the PSA blood level divided by the prostate's volume (as determined by MRI).

The JAMA Network Open study builds upon previous findings from a similar study using data only obtained at Brigham Women's Hospital, published in the Journal of the American College of Radiology in 2022. That study found that an analysis using PI-RADS and PSAD cutoffs could pinpoint up to 50% of cases in which a biopsy would be unnecessary. The new study, whose first and second authors are Arya Haj-Mirzaian, MD, MPH, and Kristine S. Burk, MD, did the same analysis on data from 72 previously published studies of men with prostate cancer, including their PI-RADS results, prostate-specific antigen density testing, and determination of clinical significance from a biopsy.


The meta-analysis gave them a dataset of more than 36,000 patients to determine if their earlier findings at BWH held in a more diverse sample set. They found that prostate biopsies may be unnecessary for patients with a PI-RADS under 4 and a PSAD below 0.10 ng/ml2. The researchers found that using specific PI-RADS and PSAD cutoffs, doctors could confidently skip 50% of biopsies while only missing 5% of clinically significant cancers, or they could skip 30% and only miss 3%.

"These data give us the confidence to say that in some cases, we can safely follow men with testing rather than aggressively pursue a biopsy in all cases," Kibel said. "By making this information available to physicians and patients, we can help them make a more informed decision about undergoing a biopsy."

The next step in this research is using the analysis to create an easy-to-use patient-level scoring system that urologists can use to evaluate their patient's need for a biopsy.

Authorship: In addition to Khorasani and Kibel, BWH authors include Arya Haj-Mirzaian, Kristine S. Burk, Ronilda Lacson, Daniel I. Glazer, and Sanjay Saini.

Disclosures: Lacson received funding from the Agency for Healthcare Research and Quality; Glazer received nonfinancial support from Siemens Healthineers for other work; and Kibel is a member of an advisory board for Blue Earth.

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