DOI: 10.1093/bjs/znad258.723 ISSN:

609 Improving Patient Counselling in Patients' With PI-RADS 3 Lesions with the Use of PSA Density, A Retrospective Study in a UK District General Hospital

S Maniarasu, M Elsayed, H Barker
  • Surgery



NICE and EAU guidelines recommend offering prostate biopsy for patients with PI-RADS 3 lesions in a multiparametric MRI. Employing PSA density (PSAd), to further risk-stratify these patients, is a promising approach to advocate for PSA surveillance over biopsies. Here, we appraise the ability of PSAd to risk-stratify PI-RADs 3 lesions across patients who underwent a prostate biopsy.


A retrospective analysis was performed on all patients who had a multiparametric MRI with PI-RADs 3 lesions over 2-year period Jan 2021 – Dec 2022. Patients were divided into two groups according to their PSAd value and whether they have neoplastic features on histopathology. The data was analysed using Chi-Square to determine the association between PSAd levels and cancer incidence in PI-RADS 3 lesions.


116 patients out of 613 had PIRADS 3 reported (19%). 83 patients had biopsies (72%). 44 was positive for neoplasia (53%) and 39 was negative (47%). 44 patients in the biopsy arm had a PSAd of <0.15 (53%). Of these patients, 27 had no neoplasia (61.4%). 39 patients had PSAd >0.15 (47%) and 12 had no neoplasia (31%). PSAd < 0.15 PI-RADS 3 lesions were significantly associated with lower occurrence of prostatic malignancy on statistical analysis.


Out of all biopsied PIRADS 3 lesions, almost half (47%) had no neoplasia. More than half of patients with PSAd <0.15 had no neoplasia. Patients with PSAD <0.15 were statistically more likely to have no neoplasia compared to patients with PSAD >0.15. This information is useful for prebiopsy risk stratification and patient counselling.

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