Published in
2023
March 2023, Volume 176, Pages 115-120; doi: 10.1016/j.urology.2023.03.014
Using IsoPSA With Prostate Imaging Reporting and Data System Score May Help Refine Biopsy Decision Making in Patients With Elevated PSA Tarik Benidir, Zaeem Lone, Andrew Wood, Nour Abdallah, Rebecca Campbell, Petar Bajic, Andrei Purysko, Jane K. Nguyen, Jihad Kaouk, Georges Pascal Haber, Mohamed Eltemamy, Robert Stein, Samuel Haywood, Eric A. Klein, Nima Almassi, Steven C. Campbell, Robert Abouassaly, and Christopher J. Weight
Objective
Methodology
To assess how IsoPSA, a structure-based serum assay which has been prospectively validated in detecting clinically significant prostate cancer (csPCa), can help the biopsy decision process when combined with the prostate imaging reporting and data systems (PI-RADS).
• Single-center (Cleveland Clinic) retrospective review of prospectively collected data from January 2019 to January 2021. • 207 patients who underwent prostate MRI, IsoPSA testing and biopsy.
Results
Conclusion
Risk of Clinically Significant Prostate Cancer IsoPSA ≤ 6
IsoPSA > 6
PI-RADS 1-2
2%
15%
PI-RADS 3
4.5%
16%
PI-RADS 4-5
19%
49%
The combination of IsoPSA with PI-RADS scores provides meaningful predicted probabilities for the likelihood of detecting csPCa at biopsy with a reassuringly low probability when PI-RADS 1 to 3 is found in conjunction with a low IsoPSA Index. Use of such prebiopsy adjuncts may provide an opportunity for shared decision making with patients on whether or not to conduct a prostate biopsy in men with initially elevated PSA.