Radical prostatectomy without prior biopsy in patients with positive PSMA PET and/or mpMRI: A practiced but poorly documented approach. Retrospective multicenter cohort study.

[INTRODUCTION] Prostate cancer (PCa) is the most common malignancy among men and currently ranks as the second leading cancer worldwide in terms of incidence. In 2021, a total of 35,764 new cases were diagnosed. The development of new imaging tools such as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PET-PSMA) has enabled the exploration of less invasive diagnostic strategies in clinically significant prostate cancer. However, performing radical prostatectomy without a prior biopsy remains an exceptional practice, scarcely documented and highly controversial.

[OBJECTIVE] To report a series of Mexican cases undergoing radical prostatectomy without prior biopsy, using PET-PSMA and mpMRI as the main diagnostic tools, and to propose a preliminary risk stratification model based on SUVmax values: the "M&M's PSMA SCORE SUVmax".

[MATERIALS AND METHODS] Retrospective, observational, multicenter study of 18 patients treated between 2021 and 2024. Clinical variables, imaging findings, and histopathological results were analyzed. Sensitivity, positive predictive value (PPV), and correlation between SUVmax and ISUP grade were calculated.

[RESULTS] All cases confirmed clinically significant adenocarcinoma. PET-PSMA showed 100% sensitivity and PPV; mpMRI showed 93.3% sensitivity and 100% PPV. A positive correlation was found between SUVmax and ISUP grade (r = 0.84; P = .038). A preliminary classification based on SUVmax cut-off points was proposed.

[CONCLUSIONS] This series suggests that, in selected contexts, PET-PSMA and mpMRI could support surgical decision-making even without prior biopsy. However, prospective studies are needed to validate both this strategy and the proposed stratification system.