{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T09:01:15Z","timestamp":1780045275832,"version":"3.53.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf (UKE)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, \u201cPI-RADS 5 patients\u201d).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>PI-RADS 5 patients who underwent MRI\/Ultrasound fusion biopsy (Bx) between 2016 and 2020 were identified in our institutional database. Uni- and multivariable logistic-regression models were used to identify predictors of csPCA-detection (GGG\u2009\u2265\u20092). Risk models were adjusted for ECE, PSA-D, and cT-stage. Corresponding Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were calculated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 493 consecutive PI-RADS 5 patients, the median age and PSA was 69\u00a0years (IQR 63\u201374) and 8.9\u00a0ng\/ml (IQR 6.0\u201313.7), respectively. CsPCA (GGG\u2009\u2265\u20092) was detected in 405\/493 (82%); 36\/493 patients (7%) had no cancer. When tabulating for PSA-D of\u2009&gt;\u20090.2\u00a0ng\/ml\/cc and\u2009&gt;\u20090.5\u00a0ng\/ml\/cc, csPCA was found in 228\/253 (90%, PI-RADS5\u2009+\u2009PSA-D\u2009&gt;\u20090.2\u00a0ng\/ml\/cc) and 54\/54 (100%, PI-RADS5\u2009+\u2009PSA-D\u2009&gt;\u20090.5\u00a0ng\/ml\/cc). Finally, a model incorporating PSA-D and cT-stage achieved an AUC of 0.79 (CI 0.74\u20130.83).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In PI-RADS 5 patients, PSA-D and cT-stage emerged as strong predictors of csPCA at biopsy. Moreover, when adding the threshold of PSA-D\u2009&gt;\u20090,5\u00a0ng\/ml\/cc, all PI-RADS 5 patients were diagnosed with csPCA. Therefore, straight treatment for PCA can be considered, especially if risk-factors for biopsy-related complications such as obligatory dual platelet inhibition are present.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-024-04894-6","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T15:02:01Z","timestamp":1710946921000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1907-3982","authenticated-orcid":false,"given":"Fabian","family":"Falkenbach","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Ambrosini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mykyta","family":"Kachanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gernot","family":"Ortner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5660-7691","authenticated-orcid":false,"given":"Tobias","family":"Maurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"K\u00f6hler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Beyersdorff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3609-3512","authenticated-orcid":false,"given":"Markus","family":"Graefen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Bud\u00e4us","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"issue":"4","key":"4894_CR1","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.eururo.2022.03.006","volume":"82","author":"B Ljungberg","year":"2022","unstructured":"Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S et al (2022) European Association of Urology Guidelines on renal cell carcinoma: the 2022 update. 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All authors directly participated in the planning, execution, or analysis of the study. This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sector. The authors have no relevant financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments and was approved by the local institutional review board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All the patients included in the study provided written informed consent for the procedure\u00a0and\u00a0data analysis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"182"}}