{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T07:06:35Z","timestamp":1788937595070,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Management of men with equivocal MRI findings remains uncertain, while low\u2010risk MRI may still harbor clinically significant prostate cancer (csPCa). We examined whether prostate\u2010specific antigen (PSA)\u2010based measures could identify a low\u2010risk subgroup suitable for biopsy deferral in patients with Prostate Imaging\u2013Reporting and Data System (PI\u2010RADS) 1\u20133 lesions, and which clinical &amp; imaging factors further refined risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective single\u2010center study included 473 consecutive patients with index PI\u2010RADS 1\u20133 findings on prostate MRI who underwent systematic and\/or MRI\/US fusion\u2010guided biopsy between May 2019 and December 2025. Patient\u2010level csPCa (grade group \u2265\u20092) detection rates (CDR) were calculated across PI\u2010RADS groups. csPCa detection, biopsy avoidance, and missed csPCa were assessed using biopsy\u2010deferral thresholds based on PSA (&lt;\u20093\u2009ng\/mL), age\u2010adjusted PSA, and PSA density (PSAD) (&lt;\u20090.10 and &lt;\u20090.15\u2009ng\/mL\n                      <jats:sup>2<\/jats:sup>\n                      ). Logistic regression analyses identified independent predictors of PCa and csPCa.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 172 patients with PI\u2010RADS 1, 126 with PI\u2010RADS 2, and 175 with PI\u2010RADS 3 index lesions. In PI\u2010RADS 1\u20132, csPCa was detected in 2.2% (1\/46) of patients with PSA\u2009&lt;\u20093, whereas for PSAD\u2009&lt;\u20090.10, the CDR was 5.3% (10\/190). Avoided biopsy rates were 15.4% (46\/298) and 63.8% (190\/298), and missed csPCa rates were 3.3% (1\/30) for PSA\u2009&lt;\u20093% and 33.3% (10\/30) for PSAD\u2009&lt;\u20090.10, respectively. In PI\u2010RADS 1\u20133, csPCa was detected in 5.6% (4\/76) of patients with PSA\u2009&lt;\u20093\u2009ng\/mL, while for PSAD\u2009&lt;\u20090.10, CDR was 8.8% (26\/295). Biopsy avoidance was 16.1% (76\/473) for PSA\u2009&lt;\u20093\u2009ng\/mL and 62.4% (295\/473) for PSAD\u2009&lt;\u20090.10, with missed csPCa rates of 5.6% (4\/71) and 36.6% (26\/71), respectively. On multivariable analysis, higher log\n                      <jats:sub>2<\/jats:sub>\n                      (PSAD) was independently associated with csPCa in both PI\u2010RADS 1\u20132 (OR, 2.171; 95% CI, 1.255\u20133.757;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) and PI\u2010RADS 1\u20133 (OR, 2.727; 95% CI, 1.844\u20134.033;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) cohorts. In patients with index PI\u2010RADS 1\u20133 findings, prior negative biopsy was independently associated with lower odds of csPCa (OR\u2009=\u20090.425; 95% CI, 0.182\u20130.991;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048). Non\u2010diagnostic MRI quality was independently associated with PCa detection in the PI\u2010RADS 1\u20132 cohort (OR, 2.367; 95% CI, 1.276\u20134.388;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In men with index PI\u2010RADS 1\u20133 lesions, PSA\u2009&lt;\u20093\u2009ng\/mL identified a very low\u2010risk subgroup with low csPCa detection, and few missed csPCa. Conventional PSAD cutoffs performed worse for biopsy deferral, with a higher rate of missed csPCa. Biopsy decisions for PI\u2010RADS 1\u20133 lesions are best guided by a composite assessment that incorporates PSA, PSAD, PI\u2010RADS category, prior biopsy status, MRI quality, and lesion burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70243","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T06:18:06Z","timestamp":1788934686000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Defining a Safe Biopsy Deferral Strategy in Patients With Low\u2010Risk or Equivocal MRI Findings Using Prostate\u2010Specific Antigen\u2010Based Metrics"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3084-4285","authenticated-orcid":false,"given":"Omer Tarik","family":"Esengur","sequence":"first","affiliation":[{"name":"Molecular Imaging Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2507-2399","authenticated-orcid":false,"given":"Stephanie A.","family":"Harmon","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7047-1739","authenticated-orcid":false,"given":"Emma J.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9469-3239","authenticated-orcid":false,"given":"Rikhil D.","family":"Makwana","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-1462","authenticated-orcid":false,"suffix":"III","given":"Donald C.","family":"Wunsch","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J.","family":"Merino","sequence":"additional","affiliation":[{"name":"Laboratory of Pathology National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6405-9269","authenticated-orcid":false,"given":"Sandeep","family":"Gurram","sequence":"additional","affiliation":[{"name":"Urologic Oncology Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter L.","family":"Choyke","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Pinto","sequence":"additional","affiliation":[{"name":"Urologic Oncology Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"},{"name":"Center for Interventional Oncology National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0853-6494","authenticated-orcid":false,"given":"Baris","family":"Turkbey","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch National Cancer Institute, National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"issue":"1","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/JU.0000000000003491","article-title":"Early Detection of Prostate Cancer: AUA\/SUO Guideline Part I: Prostate Cancer Screening","volume":"210","author":"Wei J. 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