{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:57:39Z","timestamp":1785797859014,"version":"3.56.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1131","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives:<\/jats:title>\n                  <jats:p>To compare the effect of different PSA density (PSAD) thresholds on the accuracy for clinically significant prostate cancer (csPCa) of the Prostate Imaging Reporting And Data System v.2.1 (PI-RADSv2.1).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>We retrospectively included 123 biopsy-na\u00efve men who underwent multiparametric magnetic resonance imaging (mpMRI) and transperineal mpMRI-targeted and systematic prostate biopsy between April 2019 and October 2020. mpMRI, obtained on a 3.0T magnet with a PI-RADSv2.1-compliant protocol, was read by two radiologists (&amp;gt;1500\/&amp;gt;500 mpMRI examinations). csPCa was defined as International Society of Urogenital Pathology grading group \u22652. Receiver operating characteristic analysis was used to calculate per-index lesion sensitivity, specificity, and area under the curve (AUC) of PI-RADSv.2.1 categories after adjusting for PSAD \u22650.10,\u22650.15, and \u22650.20 ng\/mL ml\u22121. Per-adjusted category cancer detection rate (CDR) was calculated, and decision analysis performed to compare PSAD-adjusted PI-RADSv.2.1 categories as a biopsy trigger.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>csPCa prevalence was 43.9%. PSAD-adjustment increased the CDR of PI-RADSv2.1 category 4. Sensitivity\/specificity\/AUC were 92.6%\/53.6%\/0.82 for unadjusted PI-RADS, and 85.2%\/72.4%\/0.84, 62.9%\/85.5%\/0.83, and 92.4%\/53.6%\/0.82 when adjusting PI-RADS categories for a 0.10, 0.15, and 0.20 ng\/ml ml\u22121 PSAD threshold, respectively. Triggering biopsy for PI-RADS four lesions and PSAD \u22650.10 ng\/mL ml\u22121 was the strategy with greatest net benefit at 30 and 40% risk probability (0.307 and 0.271, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions:<\/jats:title>\n                  <jats:p>PI-RADSv2.1 category four with PSAD \u22650.10 ng\/mL ml\u22121 was the biopsy-triggering cut-off with the highest net benefit in the range of expected prevalence for csPCa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Advances in knowledge:<\/jats:title>\n                  <jats:p>0.10 ng\/mL ml\u22121 is the PSAD threshold with higher clinical utility in stratifying the risk for prostate cancer of PI-RADSv.2.1 categories.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1259\/bjr.20210886","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T18:35:45Z","timestamp":1636655745000},"source":"Crossref","is-referenced-by-count":27,"title":["Comparison of different thresholds of PSA density for risk stratification of PI-RADSv2.1 categories on prostate MRI"],"prefix":"10.1093","volume":"95","author":[{"given":"Rossano","family":"Girometti","sequence":"first","affiliation":[{"name":"Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Giannarini","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Panebianco","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Maresca","sequence":"additional","affiliation":[{"name":"Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Cereser","sequence":"additional","affiliation":[{"name":"Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"De Martino","sequence":"additional","affiliation":[{"name":"Division of Medical Statistic, Department of Medicine, University of Udine , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Pizzolitto","sequence":"additional","affiliation":[{"name":"Pathology Unit, Santa Maria della Misericordia University Hospital , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Pecoraro","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Ficarra","sequence":"additional","affiliation":[{"name":"Department of Human and Paediatric Pathology \u201cGaetano Barresi\u201d, Urologic Section,University of Messina , Messina , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Zuiani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Valotto","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital , Udine , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,11]]},"reference":[{"key":"2024050216101602800_b1","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1056\/NEJMoa1801993","article-title":"MRI-targeted or standard biopsy for prostate-cancer diagnosis","volume":"378","author":"Kasivisvanathan","year":"2018","journal-title":"N Engl J Med"},{"key":"2024050216101602800_b2","doi-asserted-by":"crossref","first-page":"e180219","DOI":"10.1001\/jamanetworkopen.2018.0219","article-title":"Assessment of the diagnostic accuracy of biparametric magnetic resonance imaging for prostate cancer in biopsy-naive men","volume":"1","author":"Boesen","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2024050216101602800_b3","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.eururo.2018.11.023","article-title":"Head-To-Head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in Biopsy-na\u00efve men with elevated prostate-specific antigen: a large prospective multicenter clinical study","volume":"75","author":"van der Leest","year":"2019","journal-title":"Eur Urol"},{"key":"2024050216101602800_b4","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S1470-2045(18)30569-2","article-title":"Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study","volume":"20","author":"Rouvi\u00e8re","year":"2019","journal-title":"Lancet Oncol"},{"key":"2024050216101602800_b5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002813","article-title":"Validation of IMPROD biparametric MRI in men with clinically suspected prostate cancer: a prospective multi-institutional trial","volume":"16","author":"Jambor","year":"2019","journal-title":"PLoS Med"},{"key":"2024050216101602800_b6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/bju.15277","article-title":"Risk-adapted biopsy decision based on prostate magnetic resonance imaging and prostate-specific antigen density for enhanced biopsy avoidance in first prostate cancer diagnostic evaluation","volume":"127","author":"Schoots","year":"2021","journal-title":"BJU Int"},{"key":"2024050216101602800_b7","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1148\/radiol.2019182946","article-title":"PI-RADS Steering Committee: the PI-RADS multiparametric MRI and MRI-directed biopsy pathway","volume":"292","author":"Padhani","year":"2019","journal-title":"Radiology"},{"key":"2024050216101602800_b8","doi-asserted-by":"crossref","DOI":"10.1259\/bjr.20191050","article-title":"Impact of PI-RADS category 3 lesions on the diagnostic accuracy of MRI for detecting prostate cancer and the prevalence of prostate cancer within each PI-RADS category: a systematic review and meta-analysis","volume":"94","author":"Wadera","year":"2021","journal-title":"Br J Radiol"},{"key":"2024050216101602800_b9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2214\/AJR.20.24268","article-title":"PI-RADS Committee position on MRI without contrast medium in biopsy-naive men with suspected prostate cancer: narrative review","volume":"216","author":"Schoots","year":"2021","journal-title":"American Journal of Roentgenology"},{"key":"2024050216101602800_b10","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/bju.14049","article-title":"Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy-na\u00efve men with suspicion of prostate cancer","volume":"122","author":"Hansen","year":"2018","journal-title":"BJU Int"},{"key":"2024050216101602800_b11","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.juro.2018.08.046","article-title":"Which patients with negative magnetic resonance imaging can safely avoid biopsy for prostate cancer?","volume":"201","author":"Oishi","year":"2019","journal-title":"J Urol"},{"key":"2024050216101602800_b12","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1148\/radiol.2016152827","article-title":"In-Bore 3-T MR-guided transrectal targeted prostate biopsy: prostate imaging reporting and data system version 2-based diagnostic performance for detection of prostate cancer","volume":"283","author":"Tan","year":"2017","journal-title":"Radiology"},{"key":"2024050216101602800_b13","doi-asserted-by":"crossref","first-page":"847","DOI":"10.2214\/AJR.18.20571","article-title":"A systematic review of the existing prostate imaging reporting and data system version 2 (PI-RADSv2) literature and subset meta-analysis of PI-RADSv2 categories stratified by Gleason scores","volume":"212","author":"Barkovich","year":"2019","journal-title":"AJR Am J Roentgenol"},{"key":"2024050216101602800_b14","doi-asserted-by":"crossref","first-page":"846.e9","DOI":"10.1016\/j.urolonc.2020.05.024","article-title":"Clinical utility of PsaD combined with PI-RADS category for the detection of clinically significant prostate cancer","volume":"38","author":"Stevens","year":"2020","journal-title":"Urol Oncol"},{"key":"2024050216101602800_b15","first-page":"30142","article-title":"Combined use of prostate-specific antigen density and magnetic resonance imaging for prostate biopsy decision planning: a retrospective multi-institutional study using the prostate magnetic resonance imaging outcome database (PROMOD","volume":"21","author":"Falagario","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"2024050216101602800_b16","doi-asserted-by":"crossref","first-page":"4767","DOI":"10.1007\/s00330-017-4858-0","article-title":"Mri findings in men on active surveillance for prostate cancer: does dutasteride make MRI visible lesions less conspicuous? results from a placebo-controlled, randomised clinical trial","volume":"27","author":"Giganti","year":"2017","journal-title":"Eur Radiol"},{"key":"2024050216101602800_b17","article-title":"Influence of 5-alpha reductase inhibitors on prostate cancer detection with magnetic resonance imaging: a matched cohort study","volume":"6","author":"Purysko","year":"2021","journal-title":"J Urol"},{"key":"2024050216101602800_b18","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.eururo.2004.05.008","article-title":"Efficacy and safety of long-term treatment with the dual 5\u03b1-reductase inhibitor dutasteride in men with symptomatic benign prostatic hyperplasia","volume":"46","author":"Debruyne","year":"2004","journal-title":"Eur Urol"},{"key":"2024050216101602800_b19","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.eururo.2019.02.033","article-title":"Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2","volume":"76","author":"Turkbey","year":"2019","journal-title":"Eur Urol"},{"key":"2024050216101602800_b20","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/PAS.0000000000000530","article-title":"The 2014 International Society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system","volume":"40","author":"Epstein","year":"2016","journal-title":"Am J Surg Pathol"},{"key":"2024050216101602800_b21","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-10-89","article-title":"A note on Youden\u2019s Jand its cost ratio","volume":"10","author":"Smits","year":"2010","journal-title":"BMC Med Res Methodol"},{"key":"2024050216101602800_b22","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1177\/0272989X06295361","article-title":"Decision curve analysis: a novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Med Decis Making"},{"key":"2024050216101602800_b23","doi-asserted-by":"crossref","first-page":"i6","DOI":"10.1136\/bmj.i6","article-title":"Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests","volume":"352","author":"Vickers","year":"2016","journal-title":"BMJ"},{"key":"2024050216101602800_b24","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/EDE.0b013e3181c30fb2","article-title":"Assessing the performance of prediction models: a framework for traditional and novel measures","volume":"21","author":"Steyerberg","year":"2010","journal-title":"Epidemiology"},{"key":"2024050216101602800_b25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/jmri.27546","article-title":"Performance of prostate imaging reporting and data system version 2.1 for diagnosis of prostate cancer: a systematic review and meta-analysis","volume":"54","author":"Park","year":"2021","journal-title":"J Magn Reson Imaging"},{"key":"2024050216101602800_b26","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.euo.2018.09.001","article-title":"Prebiopsy Biparametric magnetic resonance imaging combined with prostate-specific antigen density in detecting and ruling out Gleason 7-10 prostate cancer in Biopsy-na\u00efve men","volume":"2","author":"Boesen","year":"2019","journal-title":"Eur Urol Oncol"},{"key":"2024050216101602800_b27","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.euo.2019.08.015","article-title":"Avoiding unnecessary magnetic resonance imaging (MRI) and biopsies: negative and positive predictive value of MRI according to prostate-specific antigen density, 4Kscore and risk calculators","volume":"3","author":"Falagario","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"2024050216101602800_b28","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.euo.2019.08.008","article-title":"Prebiopsy IMPROD biparametric magnetic resonance imaging combined with prostate-specific antigen density in the diagnosis of prostate cancer: an external validation study","volume":"3","author":"Knaapila","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"2024050216101602800_b29","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/bju.14049","article-title":"Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy-na\u00efve men with suspicion of prostate cancer","volume":"122","author":"Hansen","year":"2018","journal-title":"BJU Int"},{"key":"2024050216101602800_b30","doi-asserted-by":"crossref","first-page":"70","DOI":"10.21037\/tau.2017.12.31","article-title":"Mri in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?","volume":"7","author":"Schoots","year":"2018","journal-title":"Transl Androl Urol"},{"key":"2024050216101602800_b31","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.eururo.2020.03.048","article-title":"Negative predictive value of multiparametric magnetic resonance imaging in the detection of clinically significant prostate cancer in the prostate imaging reporting and data system era: a systematic review and meta-analysis","volume":"78","author":"Sathianathen","year":"2020","journal-title":"Eur Urol"},{"key":"2024050216101602800_b32","first-page":"30212","article-title":"Positive predictive value of prostate imaging reporting and data system version 2 for the detection of clinically significant prostate cancer: a systematic review and meta-analysis","volume":"25","author":"Mazzone","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"2024050216101602800_b33","doi-asserted-by":"crossref","first-page":"895.e1","DOI":"10.1016\/j.crad.2019.08.020","article-title":"Similarities and differences between Likert and PIRADS v2.1 scores of prostate multiparametric MRI: a pictorial review of histology-validated cases","volume":"74","author":"Latifoltojar","year":"2019","journal-title":"Clin Radiol"},{"key":"2024050216101602800_b34","article-title":"Comparison of PI-RADS versions 2.0 and 2.1 for MRI-based calculation of the prostate volume","volume":"4","author":"Ghafoor","year":"2020","journal-title":"Acad Radiol"},{"key":"2024050216101602800_b35","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.eururo.2015.08.052","article-title":"PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2","volume":"69","author":"Weinreb","year":"2016","journal-title":"Eur Urol"},{"key":"2024050216101602800_b36","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.clinimag.2021.09.003","article-title":"Which measurement method should be used for prostate volume for PI-RADS? A comparison of ellipsoid and segmentation methods","volume":"80","author":"Colvin","year":"2021","journal-title":"Clin Imaging"},{"key":"2024050216101602800_b37","doi-asserted-by":"crossref","first-page":"W720","DOI":"10.2214\/AJR.12.9712","article-title":"Fully automated prostate segmentation on MRI: comparison with manual segmentation methods and specimen volumes","volume":"201","author":"Turkbey","year":"2013","journal-title":"AJR Am J Roentgenol"}],"container-title":["The British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/95\/1131\/20210886\/57371326\/bjr.20210886.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/95\/1131\/20210886\/57371326\/bjr.20210886.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T18:34:14Z","timestamp":1714674854000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/doi\/10.1259\/bjr.20210886\/7451515"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,11]]},"references-count":37,"journal-issue":{"issue":"1131","published-online":{"date-parts":[[2021,11,11]]},"published-print":{"date-parts":[[2022,3,1]]}},"URL":"https:\/\/doi.org\/10.1259\/bjr.20210886","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,3,1]]},"published":{"date-parts":[[2021,11,11]]},"article-number":"20210886"}}