PD57-07: Factors Predicting Clinically Significant Prostate Cancer in PIRADS 4 Lesions

Mohammad siddiqui*, jasmine Lin, Jonathan Aguiar, Brandon Ansbro, Moataz Soliman, Jordan Rich, Johan Alfaro, Mary-Kate Keeter, Quan Mai, Edward Schaeffer, Ashley Ross, chicago, IL

Introduction: The PIRADS 4 lesions are commonly biopsied, however many are benign. Here, we sought to investigate factors that may help better risk stratify the PIRADS-4 lesions and predict the presence of clinically significant cancer (defined as Gleason Grade Group (GG) = 2).

Methods: We queried the electronic medical record for patients diagnosed with PIRADS 4 lesions beginning in March 2018 with the focus on patients with total PSA 2-20ng/mL. We compared the clinical characteristics such as Age, African American race, PSA, prostate health index (PHI), and PSA Density (PSAD) of patients with and without clinically significant prostate cancer on biopsy. Statistics were performed using t-test, chi-squared analysis, and logistical regressions with significance defined as p<0.05.

Results: From March 2018 to present, 3553 men presented to urology with suspicion of prostate cancer and 1640 (46%) underwent prostate MRI. 571 (35%) of men were identified to have the PIRADS 4 lesion as their highest PIRADS lesion (Table 1). 556 (97%) men with PIRADS 4 lesions underwent prostate needle biopsy.  Clinically significant cancer was detected in 288 (52%) of this population (206 (37%) men had negative biopsies, while GG1 was found in 61 (11%)). Predictors of identifying clinically significant prostate cancer on biopsy on multivariable analysis included African American race (OR 3.76, 95% CI 1.86-7.59), PSAD >0.15 (OR 3.01, 95% CI 1.5-5.74) and higher PHI (PHI>36 (OR 3.42, CI 1.58-7.4), PHI= 55(OR 10.5, 95% CI 4.07-25.1)).

Conclusions: Consistent with literature, 37% of PIRADS 4 lesions are benign in our series. Our results suggest that men of AA race, or those with PSAD> 0.15, or PHI >36 and PIRADS 4 lesions should undergo prostate biopsy.  Men with PSAD < 0.1 and PHI scores in the lowest quartile were least likely to have clinically significant prostate cancer on biopsy of PIRADS 4 lesions.

Source of Funding: UROLOGY CARE FOUNDATION RESIDENCY RESEARCH AWARD