Introduction:

Over the past 10 years, MRI incorporation into prostate cancer screening protocols have been associated with decreased rates of low-risk prostate cancer diagnosis likely due to decreased numbers of overall biopsies performed. Whether this has changed characteristics of patients with newly diagnosed very low- or low-risk disease has not been fully described, especially in light of the recent removal of very low-risk disease from the AUA guidelines. The aim of this study was to evaluate the trend of newly diagnosed prostate cancer based on AUA and NCCN risk categories after screening with PSA and MRI at a single center equal access intuition.  

Methods:

A prospective chart review study was conducted on all patients undergoing a prostate biopsy at our local VA hospital from 1/2018 to 12/2022. Patients were included into this study under the following criteria: 1) Male patients who underwent an MRI and PSA drawn prior to biopsy; 2) Uronav biopsy of ROI lesion; 3) Full data available at the time of data lock. Patients were excluded if the biopsy indication was solely based on PSA or diagnosed on TURP. Statistics were completed using R computational language. Non-parametric data was evaluated using a a Mann-Whitney U and categorical data using fisher tests. All tests were two sided using a significance of 0.05. Clinically significant prostate cancer (csPCa) was defined as any gleason grade ≥3+4. 

Results:

A total of 662 patients were entered into this study. The median age was 67.7 years old, BMI of 28.29, and PSA prior to biopsy of 5.9 with 62.2% (n = 412) of men self-identified as African American. Upon AUA risk stratifying, 260 (39.3%) had benign pathology, 105 (15.9%) low risk, 75 (11.3%) intermediate favorable, 107 (16.2%) intermediate unfavorable, and 115 (17.4%) patients were classified as high/very high risk. When stratifying the AUA low risk men by NCCN guidelines, 64 (10%) were categorized as very low and 41 (6%) as low risk prostate cancer. Patients were then separated by year and PI-RADS. There has been a stable trend in diagnosing new very low risk disease from 2018 through 2022 across all PI-RADS. Delineation was then completed based on race. African American (AA) and non-AA men showed comparable rates of csPCa across all PI-RADS and year over year trend.

Conclusion:

While MRI has been significantly impactful to reduce overdiagnosis and overtreatment, patients with very low risk disease are routinely being identified. More research is needed to help elucidate patients who harbor clinically localized and indolent disease away from biopsy intense protocols. This study also found AA patients, who have been classically hypothesised to harbor higher risk disease at higher rates, were diagnosed with csPCa at comparable rates to their non-AA counterparts. This builds on the body of research which advocates that race no longer becomes a csPCa risk factor in an equal access setting.  

Funding: N/A