Factors Associated With Early Detection of Clinically Significant Prostate Cancer After a Negative Magnetic Resonance Imaging-Informed Biopsy.

[INTRODUCTION] Multiparametric MRI (mpMRI) has improved detection of clinically significant prostate cancer (csPCa). However, negative biopsies still occur, and limited evidence exists to guide follow-up after a negative biopsy. This study aimed to identify clinicopathological factors associated with detection of csPCa within 2 years of an initial negative biopsy informed by mpMRI.

[METHODS] We identified patients with a negative biopsy informed by mpMRI who underwent at least 1 repeat biopsy within 2 years. Individuals with prior prostate cancer were excluded. The primary outcome was csPCa, defined as Gleason Grade Group 2 or higher, on repeat biopsy. Baseline and follow-up characteristics were analyzed, and logistic regression models were constructed.

[RESULTS] Among 1790 patients with an initial negative biopsy, 176 underwent repeat biopsy and 33 (18.8%) were diagnosed with csPCa. These patients had a higher PSA density, Prostate Imaging Reporting and Data System (PI-RADS) 4 to 5 on baseline MRI, and absence of inflammation on initial biopsy. The model using these features produced an AUC of 0.752. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on baseline biopsy were not associated. Replacing initial imaging findings with persistent PI-RADS 4 or 5 findings on repeat mpMRI modestly improved performance (AUC = 0.780).

[CONCLUSIONS] Higher PSA density, PI-RADS 4 to 5 on baseline mpMRI, and absence of inflammation on baseline biopsy were associated with detection of csPCa. Persistent PI-RADS 4 to 5 on repeat mpMRI further increased risk. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation were not associated with csPCa detection.