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What is it about?
This study aimed to identify the optimal 4Kscore thresholds to determine the need for a prostate biopsy when multiparametric magnetic resonance imaging (MRI) (mpMRI) is negative or indeterminate. The study analyzed retrospective data from 1111 men who underwent an mpMRI, 4Kscore, and prostate biopsy for evaluation of prostate cancer. The 4Kscore values were categorized into ranges of 1-7, 8-19, 20-32, and greater than 32. The study found that in men with a negative mpMRI, a 4Kscore ≥33 should suggest the need for prostate biopsy due to increased risk of clinically significant prostate cancer (csPCa). Alternatively, men with a score below 33 had a less than 10% risk of csPCa. In patients with an equivocal lesion on mpMRI, men with a 4Kscore cutoff greater than 8 had a greater than 20% risk of csPCa. This study provides valuable information to guide providers on how to best utilize multiparametric MRI and biomarkers in combination for prostate cancer evaluation.
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Why is it important?
This research is important for several reasons. Firstly, it helps to identify the optimal 4Kscore thresholds for determining the need for a prostate biopsy when mpMRI is negative or indeterminate. This information can be used to optimize the use of mpMRI and biomarkers in biopsy decision-making, helping to achieve a more delicate balance between detecting clinically significant disease while avoiding an unnecessary and risk-prone procedure. Secondly, it provides valuable information to guide providers on how to best utilize these tools in combination, enhancing the selection of patients for biopsy compared with either test alone. Finally, it helps to improve risk stratification in patients with negative or equivocal mpMRI results, potentially reducing the number of unnecessary biopsies and improving patient outcomes. Key Takeaways: 1. A 4Kscore cutoff of 33 resulted in an increased risk of GG2+ cancer on biopsy in men with a negative mpMRI, suggesting that a 4Kscore ≥33 should suggest the need for prostate biopsy due to increased risk of csPCa. 2. Men with a 4Kscore cutoff below 33 had a less than 10% risk of csPCa, suggesting that those with a score below 33 may be able to safely avoid biopsy due to a low risk of csPCa. 3. In men with an equivocal mpMRI, a 4Kscore cutoff greater than 8 was associated with a greater than 20% risk of csPCa, suggesting that patients with a 4Kscore less than 8 may be able to safely avoid biopsy due to a low risk of csPCa, whereas those with a 4Kscore above 8 have a significantly increased risk of csPCa and may want to consider biopsy. 4. Using a 4Kscore of 8 as a cutoff for initiating prostate biopsy in men with a negative mpMRI would have allowed for 82% of biopsies to be avoided, including deferring prostate biopsy in 77% of those with an indolent cancer and 42% with a clinically significant cancer.
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This page is a summary of: Optimum threshold of the 4Kscore for biopsy in men with negative or indeterminate multiparametric magnetic resonance imaging, BJUI Compass, May 2023, Wiley,
DOI: 10.1002/bco2.235.
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